Guidelines for medical and health information sites on the internet: principles governing AMA web sites. American Medical Association.

Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.

[Efficacy and tolerability of paroxetine in the treatment of the depressive phase of bipolar disorders]. / La paroxetina nel disturbo bipolare in fase depressiva.

Eighty patients aged between 20-65 years and suffering from bipolar disease according to DSM IV criteria, were treated with paroxetine for os at the single dosage of 20-40 mg/die. At regular intervals psychometric reagents were administered for the evaluation and the variations in the bipolar disease. Tolerability was excellent and side-effects mild, with a tendency to regress after the second week of therapy. The clinical assessment and the psychometric findings both suggest that paroxetina has a useful action on the bipolar disease.

The effect of mesoglycan in patients with cerebrovascular disease: a psychometric evaluation.

Mesoglycan is a preparation of natural glycosaminoglycans, containing mainly heparan sulphate and dermatan sulphate. A clinical trial was conducted to evaluate the efficacy and the tolerability of once-daily mesoglycan in 30 patients with clinical evidence of cerebrovascular insufficiency. Clinical effectiveness was assessed using psychometric and neurological scales: Sandoz Clinical Assessment for Geriatric Patients (SCAG); Parkside Behaviour Rating Scale Modified; Geriatric Depression Scale; and Anxiety Evaluation. Mesoglycan was given as a single oral once-daily dose of 100 mg for a period of 6 months. This treatment was shown to have positive effects on the cognitive and behavioural parameters evaluated. The effects on SCAG were already evident after 3 months' treatment and a significant improvement was observed after 6 months in those patients with a moderate to severe disease. During the treatment period only one patient suffered an adverse reaction attributed to the drug investigated.

Collaborative production and resource allocation: the consequences of prospective payment for hospital care.

This article presents a model of the intensity of care provided by hospitals and physicians and how such intensity was affected by the change to prospective payment by Medicare. Prospective payment introduced an incentive for hospitals to shorten average length of stay, but in order to keep the patient recovery level constant, intensity of inpatient care was forced to increase. Physicians reacted to hospital changes by increasing their own intensity of care provided to inpatients. Implications of the model for admissions and physician office time are also explored. Empirical results indicate that for the period 1983-1987, spanning the introduction of PPS, both hospital and physician intensity of care per inpatient rose significantly.

The production of health care services and changing hospital reimbursement. The role of hospital-medical staff relationships.

The production of health care services has the unique feature that physicians do not face explicit costs for hospital inputs. This paper develops models of the production process given alternative hospital and medical staff relationships, and analyzes the impact of the change in hospital reimbursement under Medicare from a cost-based system to the Prospective Payment System (PPS). A basic theoretical result finds that the switch to PPS forces physicians to alter their input mix, changing both physician and hospital income. The effects of the introduction of PPS on hospital inputs, physician income, and hours of work are empirically examined.

The privatization of health care and physicians' perceptions of access to hospital services.

Health care in the United States is increasingly delivered by for-profit providers, by multi-facility corporations, and under conditions of price-based competition. The joint influence of these three trends is examined through data drawn from a 1984 survey of physicians conducted by the American Medical Association. For-profit ownership and price competition are reported to restrict admission for the poor and uninsured; the effects of system affiliation are shown to be more complex. Policy responses to future restrictions on access are discussed.

Hospitals in transition: a perspective.

In recent years, a number of developments have had a far-reaching impact on the structure of the hospital industry. These include the emergence of for-profit corporate entities, the increasing need to access capital markets, income limitations imposed by the prospective payment system for Medicare, shortened lengths of stay, and competition among providers with an excess in bed capacity. Hospitals have responded by joining into various affiliations on a national scale, engaging in local joint ventures, and altering their mix of services.

Physician practice patterns under hospital rate-setting programs.

Earlier studies of hospital rate-setting programs have focused primarily on their ability to contain the growth in hospital utilization and expenditures. While most analysts recognize the central role physicians play in influencing health care utilization and expenditures, regulatory programs have been directed primarily at the hospital. At this time, it is unclear what impact, if any, these programs have had on physicians. Our study presents a preliminary analysis of this issue based on data from 1978 to 1982. When we compared average incomes, fees, and utilization of physician services in states with hospital rate regulations with those in states without such programs, we found significant differences. Average net incomes grew at a 1.9% slower annual rate in states with strict hospital regulatory programs. If hospital regulation is having some impact on physicians, both the physician and hospital sector should be considered when evaluating the ability of these programs to contain health care costs.

Physician acceptance of Medicare patients on assignment.

The determinants of the assignment rates of physician services under Medicare are analyzed in this paper. A theoretical model of physician behavior is developed to capture the carrot and stick nature of the assignment decision resulting from the uncertainty of patient payment. The optimization conditions of the physician's problem indicate that assignment rates are determined by market prices, Medicare fees, and physicians' assessments of their patients' payment likelihoods. The theoretical findings are tested using an empirical model based on observed prices and selected proxy variables for the probability of payment. Results, based on a Tobit analysis that predicts elasticities for the price and proxy variables, are consistent with the theoretical model implying that economic incentives and patient payment probabilities are important determinants of assignment rates.