title: [Mitigating the moral risks of private medicine in public hospitals (SHARAP) through regulation and accountability].
abstract: BACKGROUND
  SHARAP (the Hebrew acronym for private medical service) is an arrangement that allows patients in certain Israeli hospitals to choose their physicians in return for a fee paid, either privately or through some form of parallel insurance. At present, SHARAP is legally precluded from government hospitals but the issue is a source of public debate and the introduction of SHARAP into public hospitals owned by the government and health funds is supported by the Israel Medical Association and MK Yakov Litzman. While advantages to patients, hospitals and medical practitioners are acknowledged, these arrangements carry moral risks related to justice and fair allocation of resources, problems relating to conflicts of interests, the potential for exploitation of patients by physicians with private privileges and the potential for corrupt behaviors.
  
  
  OBJECTIVE
  To address the questions: Do the advantages of these arrangements justify the moral risks involved in the introduction of private medicine into public hospitals? Secondly, can these moral risks be mitigated through regulation without undermining the advantages accrued?
  
  
  METHODS
  Ethical and public health policy evaluation based on empiric data and international experience.
  
  
  RESULTS
  The potential advantages to patients, providers, hospitals and government of a SHARAP program in public hospitals may be undermined if the implementation does not incorporate regulatory structures. Appropriate regulatory precautions may mitigate most of these concerns adequately to allow all parties to enjoy benefits whilst diminishing actual harm incurred though injustice, conflicts of interest and exploitation.
authors.affiliation: Norman Levan Humanistic Medicine, Cancer Pain and Pall iative Medicine Service, Department Medical OncoLogy, Shaare Zedek Medical Center. chernyn@netvision.net.il
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Cherny
mesh_terms: D016265:Conflict of Interest / Q000331:legislation & jurisprudence; D006291:Health Policy; D006779:Hospitals, Public / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D007557:Israel; D008504:Medical Staff Privileges / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D008505:Medical Staff, Hospital / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*