Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004 Aug;39(4 Pt 1):813-23.
doi: 10.1111/j.1475-6773.2004.00259.x.

Trust in insurers and access to physicians: associated enrollee behaviors and changes over time

Rajesh Balkrishnan  1 , Mark A Hall, Stephen Blackwelder, Donald Bradley
Affiliations

Trust in insurers and access to physicians: associated enrollee behaviors and changes over time

Rajesh Balkrishnan et al. Health Serv Res. 2004 Aug.

Abstract

Objective: Most studies of trust in the medical arena have focused on trust in physicians rather than trust in health insurers, and have been cross-sectional rather than longitudinal studies. This study examined associations among trust in a managed care insurer, trust in one's primary physician, and subsequent enrollee behaviors relating to source of care. The study also documents changes in trust in the study population following the disclosure of physician incentives.

Study setting: A medium-sized (300,000 member) HMO, located in the southeastern United States.

Data collection: One to two years after baseline, we randomly resurveyed a quarter (n = 558) of the initial study population of a large intervention study designed to measure the impact of disclosing HMO financial incentives on patient trust. This follow-up study was also designed to measure the effects of trust on source of care.

Analyses: Multivariate regression analyses of survey data examined associations between baseline levels of trust and subsequent enrollee behaviors such as using a non-PCP physician without a PCP referral, as well as changes in trust since baseline.

Results: High baseline insurer trust was associated with a lower probability of a patient seeking care from a non-PCP physician (OR = 0.55, 95 percent CI: 0.33, 0.91). No long-term effects of prior disclosure of financial incentives were observed. Overall, there was a slight increase in overall trust in the insurer (1.8 percent, p < .05) but no change in trust in one's primary physician. The increase in insurer trust was primarily restricted to 23 percent of the enrollees who had changed their PCPs following the baseline survey (6.6 percent, p < .01). In multivariate analyses, changing physicians was the most significant predictor of increased insurer trust (OR = 2.17, 95 percent CI: 1.37, 3.43). CONCLUSIONS. Trust in one's insurer seems to change over time more than trust in one's primary physician, and is predictive of enrollee behaviors such as seeking care from other physicians. The ability to change physicians seems to increase trust in the insurer.

PubMed Disclaimer

References

    1. Anders G. Health against Wealth: HMOs and the Breakdown of Medical Trust. Boston: Houghton Mifflin; 1996.
    1. Anderson LA, Dedrick RF. Development of the Trust in Physician Scale A Measure to Assess Interpersonal Trust in Patient–Physician Relationships. Psychological Reports. 1990;67(3, part 2):1091–100. - PubMed
    1. Balkrishnan R, Dugan E, Camacho FT, Hall MA. Trust and Satisfaction with Physicians, Insurers, and the Medical Profession. Medical Care. 2003;41(9):1058–64. - PubMed
    1. Barber B. The Logic and Limits of Trust. New Brunswick, NJ: Rutgers University Press; 1983.
    1. Braithwaite V, Levi M. Trust and Governance. New York: Russell Sage Foundation; 1998.

Publication types

MeSH terms