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While most health care is provided at the primary care level, little research has been done to document the ethical issues of such care. A stratified random sample of 702 physicians, nurses, physical therapist, and physician assistants within one southeastern state was surveyed to determine the frequency of ethical issues in primary care. The most frequently occurring issue concerned moral decisions about the amount of time to spend with each patient. A comparison of physician and nonphysician professional groups revealed significant differences in frequencies of the issues. Age had a slight impact on the responses, while gender, religion, and region of practice had none. The study showed that the most frequently occurring issues are pragmatic, not dramatic, and center on patient self-determination, adequacy of care and professional responsibility, and distribution of resources.

Using data collected from mental health services delivery systems in 4 cities, this study examines the relationship between resource acquisition, resource utilization, and 3 types of cooperative, client-based interorganizational relationships: referrals received, referrals sent, and case coordination. Relationships were first explored for all 138 agencies in all 4 systems and then under conditions of environmental resource scarcity versus munificence, as measured by per capital mental health spending by the state. Results generally supported the 3 hypotheses proposed but were strongest for case coordination and for systems embedded in resource-scarce environments. Implications of the results for policy and research are discussed as they pertain to building a better understanding of conditions conducive to cooperation among health and human service agencies that provide community-based services to the severely mentally ill and other client groups with long-term needs.

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