Trust And Trustworthy Care In The Managed Care Era

Gray, Bradford H.

doi:10.1377/hlthaff.16.1.34

Cited by 137 publications

(91 citation statements)

References 14 publications

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“…Nevertheless, organizations can develop and implement policies to reinforce trust. 8,39 Patients who trusted their managed care organization were more likely to trust their physicians. Patients who reported having enough choice of physicians were more likely to trust their physician.…”

Section: Discussionmentioning

confidence: 99%

Patients’ trust in their physicians

et al. 1998

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OBJECTIVE:To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients' trust in their physician. DESIGN:Survey of patients of physicians in Atlanta, Georgia. PATIENTS:Subjects were 292 patients aged 18 years and older. MEASUREMENTS AND MAIN RESULTS:Scale of patients' trust in their physician was the main outcome measure. Most patients completely trusted their physicians "to put their needs above all other considerations" (69%). Patients who reported having enough choice of physician ( p Ͻ .05), a longer relationship with the physician ( p Ͻ .001), and who trusted their managed care organization ( p Ͻ .001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests. T rust is a fundamental aspect of the patient-physician relationship. 1-5 Even well-informed and knowledgeable patients have to rely on their physicians to provide them with appropriate information, keep personal information confidential, provide competent care, and act in their best interests. In spite of the importance of trust to the patient-physician relationship, there are few studies of the factors related to patients' trust in their physicians. CONCLUSIONS:One predictor of trust in social relationships is the length of those relationships, 6-8 and there is reason to believe this would hold for patient-physician relationships. 9 Having a choice of physician is important to many patients, 10-13 and it is possible that wider choices would encourage greater trust in the physician eventually chosen. Recent developments in health care delivery also make it plausible that the way physicians are paid could influence patients' trust in them. Reports regularly appear in the popular press about how new managed care arrangements may compromise the care provided to patients. Health service researchers have shown that payment methods may have an impact on clinical decision making. 14-16 We know of no empirical studies that have examined whether patients' beliefs about how their physician is paid affect their trust in the physician. In the study described herein, we interviewed a probability sample of patients covered by a large health care insurer in Atlanta. We assessed how patients thought their physicians were paid and whether their perceptions were accurate. We also examined whether availability of a choice of physicians, length of patient-physician relationship, or perceived physician payment method was related to the patients' trust in their physician. METHODS Study Design and SampleThe study was con...

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Section: Discussionmentioning

confidence: 99%

Patients’ trust in their physicians

et al. 1998

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“…These contrasting objects of trust can interact in important ways. Due to possible halo effects, patients' trust in their personal physicians may influence their trust in a hospital or health plan affiliated with their physicians (Gray 1997), or the correlative may be true: institutional trust may influence individual trust, especially in newly formed relationships (Mechanic and Schlesinger 1996;Buchanan 2000). Similarly, system trust influences new relationships, since, knowing little else about a new doctor or health plan, one is likely to begin the relationship with general attitudes about doctors or health plans (Mechanic 1996).…”

Section: Objects Of Trustmentioning

confidence: 99%

Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?

Hall

Dugan²,

Zheng³

et al. 2001

Milbank Quarterly

1,141

1,147

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Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

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“…5,10 Patients with more trust in their physician are likely to be more satisfi ed with care 5,[11][12][13][14] and to have positive clinical outcomes. 5,9,11 In recent years, patient trust has been challenged by perceived confl icts of interest inherent in managed care 8,[15][16][17][18][19][20] and by societal changes leading to increased patient autonomy and information access. In an era of increased cultural diversity and potential language barriers, trust is crucial for patients struggling to accept diagnoses and to follow complex treatment plans.…”

Section: Introductionmentioning

confidence: 99%

Trust in One's Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

Tarn

Meredith²,

Kagawa‐Singer³

et al. 2005

The Annals of Family Medicine

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PURPOSE Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients.METHODS A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan.RESULTS Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, Englishspeaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001).CONCLUSIONS Religiosity, autonomy preference, and acculturation were strongly related to trust in one's physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians. INTRODUCTIONT rust between a patient and physician is a cornerstone of the patientphysician relationship.1,2 Trust can facilitate health information exchange, 3 as well as determine a patient' s willingness to seek care, 3,4 receptivity to health promotion counseling, 5-7 openness to examination and treatment, 4,5,[7][8][9][10][11] and likelihood of return for follow-up care. 5,10 Patients with more trust in their physician are likely to be more satisfi ed with care 5,[11][12][13][14] and to have positive clinical outcomes. 5,9,11 In recent years, patient trust has been challenged by perceived confl icts of interest inherent in managed Derjung M. Tarn, MD, MS 1 Lisa S. Meredith, PhD 2 Marjorie Kagawa-Singer, RN, PhD 3 Shinji Matsumura, MD, MSHS 4 Seiji Bito, MD, MSHS 5 Robert K. Oye, MD 6 Honghu Liu, PhD 6 Katherine L. Kahn, MD 6 Shunichi Fukuhara, MD 7 Neil S. Wenger, MD, MPH 8,[15][16][17][18][19][20] and by societal changes lea...

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Trust And Trustworthy Care In The Managed Care Era

Cited by 137 publications

References 14 publications

Patients’ trust in their physicians

Patients’ trust in their physicians

Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?

Trust in One's Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

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