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June 5, 1996, Vol 275, No. 21 >
ARTICLE | June 5, 1996

The Impact of Managed Care on Patients' Trust in Medical Care and Their Physicians FREE

David Mechanic, PhD; Mark Schlesinger, PhD
[+] Author Affiliations

Corresponding author: David Mechanic, PhD, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Ave, New Brunswick, NJ 08903.

The Patient-Physician Relationship section editor: Richard M. Glass, MD, Deputy Editor, JAMA.


JAMA. 1996;275(21):1693-1697. doi:10.1001/jama.1996.03530450083048
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References

Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority. Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients. Gatekeeping and incentives to limit care also raise serious trust issues. We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance.

(JAMA. 1996;275:1693-1697)

REFERENCES

1 +
Blendon RJ, Hyams TS, Benson JM.  Bridging the gap between expert and public views on health care reform. JAMA . 1993;;269:2573-2578.
2 +
Blendon RJ, Taylor H.  Views on health care: public opinion in three nations. Health Aff (Millwood) . 1989;;8:149-157.
3 +
Mechanic D.  Changing medical organization and the erosion of trust. Milbank Q . 1996;;74:171-189.
4 +
Ryan KJ.  The threat of litigation. J R Soc Med . 1994;;87( (suppl 22) ):17-18.
5 +
Emmons D, Chawla A.  Physician perceptions of the intrusiveness of utilization review.  In: Marder W, ed. Socioeconomic Characteristics of Medical Practice . Chicago, Ill: American Medical Association; 1991;.
6 +
Luhman N. Trust and Power . New York, NY: John Wiley & Sons Inc; 1989;.
7 +
Sheils JF, Young GJ, Rubin RJ.  O Canada: do we expect too much from its health system? Health Aff (Millwood) . 1992;;11:7-20.
8 +
Hillman A, Welch WP, Pauly M.  Contractual arrangements between HMOs and primary care physicians: three-tiered HMOs and risk pools. Med Care . 1992;;30:136-148.
9 +
Hillman A, Pauly M, Kerstein JJ.  Do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med . 1989;;321:86-95.
10 +
Mechanic D, Ettel T, Davis D.  Choosing among health care options. Inquiry . 1990;;27:14-23.
11 +
Shaver KG. The Attribution of Blame: Causality, Responsibility and Blameworthiness . New York, NY: Springer-Verlag; 1985;.
12 +
McGraw KM.  Avoiding blame: an experimental investigation of political excuses and justifications. Br J Polit Sci . 1989;;20:119-142.
13 +
Hibbard J, Weeks E.  Consumerism in health care: prevalence and predictions. Med Care . 1987;;25:1019-1032.
14 +
Pear R.  Doctors say HMO's limit what they can tell patients. New York Times . (December 21) , 1995;:A1.
15 +
Schlesinger M, Gray B, Perreira K.  Deprofessionalization or reprofessionalization: the impact of utilization review on American medicine. Health Aff (Millwood) . In press.
16 +
Davis K, Collins KS, Schoen C, Morris C.  Choice matters: enrollees' views of their health care plans. Health Aff (Millwood) . 1995;;14:99-112.
17 +
Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR.  Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitis treated by different systems and specialties: results from the Medical Outcomes Study. JAMA . 1995;;274:1436-1444.
18 +
Gillis CR, Hole DJ.  Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ . 1996;; 312:145-148.
19 +
Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr.  Detection of depressive disorders for patients receiving prepaid or fee for service care: results from the Medical Outcomes Study. JAMA . 1989;;262:3298-3302.
20 +
Hays RD, Wells KB, Sherbourne D, Rogers W, Spritzer K.  Functioning and well-being of patients with depression compared with chronic medical conditions. Arch Gen Psychiatry . 1995;;52:11-19.
21 +
Rosenthal E.  Managed care has trouble treating AIDS, patients say. New York Times . (January 15) , 1996;:1.
22 +
Macklin R. Enemies of Patients . New York, NY: Oxford University Press; 1993;.
23 +
Kassirer JP.  Managed care and the morality of the marketplace. N Engl J Med . 1995;;333:50-52.
24 +
Lupton D, Donaldson C, Lloyd P.  Caveat emptor or blissful ignorance? patients and the consumerist ethos. Soc Sci Med . 1991;;33:559-568.
25 +
Rodwin M. Medicine, Money and Morals: Physicians' Conflicts of Interest . New York, NY: Oxford University Press; 1993;.
26 +
Health Care Financing Administration. Medicare and Medicaid Programs; Requirements for Physician Incentive Plans in Prepaid Health Care Organizations. 42 CFR §417 and 434; April 12, 1996.
27 +
Emanuel E, Dubler N.  Preserving the physician-patient relationship in the era of managed care. JAMA . 1995;;273:323-329.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Blendon RJ, Hyams TS, Benson JM.  Bridging the gap between expert and public views on health care reform. JAMA . 1993;;269:2573-2578.
2 +
Blendon RJ, Taylor H.  Views on health care: public opinion in three nations. Health Aff (Millwood) . 1989;;8:149-157.
3 +
Mechanic D.  Changing medical organization and the erosion of trust. Milbank Q . 1996;;74:171-189.
4 +
Ryan KJ.  The threat of litigation. J R Soc Med . 1994;;87( (suppl 22) ):17-18.
5 +
Emmons D, Chawla A.  Physician perceptions of the intrusiveness of utilization review.  In: Marder W, ed. Socioeconomic Characteristics of Medical Practice . Chicago, Ill: American Medical Association; 1991;.
6 +
Luhman N. Trust and Power . New York, NY: John Wiley & Sons Inc; 1989;.
7 +
Sheils JF, Young GJ, Rubin RJ.  O Canada: do we expect too much from its health system? Health Aff (Millwood) . 1992;;11:7-20.
8 +
Hillman A, Welch WP, Pauly M.  Contractual arrangements between HMOs and primary care physicians: three-tiered HMOs and risk pools. Med Care . 1992;;30:136-148.
9 +
Hillman A, Pauly M, Kerstein JJ.  Do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med . 1989;;321:86-95.
10 +
Mechanic D, Ettel T, Davis D.  Choosing among health care options. Inquiry . 1990;;27:14-23.
11 +
Shaver KG. The Attribution of Blame: Causality, Responsibility and Blameworthiness . New York, NY: Springer-Verlag; 1985;.
12 +
McGraw KM.  Avoiding blame: an experimental investigation of political excuses and justifications. Br J Polit Sci . 1989;;20:119-142.
13 +
Hibbard J, Weeks E.  Consumerism in health care: prevalence and predictions. Med Care . 1987;;25:1019-1032.
14 +
Pear R.  Doctors say HMO's limit what they can tell patients. New York Times . (December 21) , 1995;:A1.
15 +
Schlesinger M, Gray B, Perreira K.  Deprofessionalization or reprofessionalization: the impact of utilization review on American medicine. Health Aff (Millwood) . In press.
16 +
Davis K, Collins KS, Schoen C, Morris C.  Choice matters: enrollees' views of their health care plans. Health Aff (Millwood) . 1995;;14:99-112.
17 +
Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR.  Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitis treated by different systems and specialties: results from the Medical Outcomes Study. JAMA . 1995;;274:1436-1444.
18 +
Gillis CR, Hole DJ.  Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ . 1996;; 312:145-148.
19 +
Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr.  Detection of depressive disorders for patients receiving prepaid or fee for service care: results from the Medical Outcomes Study. JAMA . 1989;;262:3298-3302.
20 +
Hays RD, Wells KB, Sherbourne D, Rogers W, Spritzer K.  Functioning and well-being of patients with depression compared with chronic medical conditions. Arch Gen Psychiatry . 1995;;52:11-19.
21 +
Rosenthal E.  Managed care has trouble treating AIDS, patients say. New York Times . (January 15) , 1996;:1.
22 +
Macklin R. Enemies of Patients . New York, NY: Oxford University Press; 1993;.
23 +
Kassirer JP.  Managed care and the morality of the marketplace. N Engl J Med . 1995;;333:50-52.
24 +
Lupton D, Donaldson C, Lloyd P.  Caveat emptor or blissful ignorance? patients and the consumerist ethos. Soc Sci Med . 1991;;33:559-568.
25 +
Rodwin M. Medicine, Money and Morals: Physicians' Conflicts of Interest . New York, NY: Oxford University Press; 1993;.
26 +
Health Care Financing Administration. Medicare and Medicaid Programs; Requirements for Physician Incentive Plans in Prepaid Health Care Organizations. 42 CFR §417 and 434; April 12, 1996.
27 +
Emanuel E, Dubler N.  Preserving the physician-patient relationship in the era of managed care. JAMA . 1995;;273:323-329.

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