New Study Asks, ‘Why Is Trust in Health Care Declining?’

Rajesh Balkrishnan, Ph.D.

Many patients say they still trust their doctors, but they admit they’re anxious when it comes to trusting their health insurers, reports a new study led by a researcher from The University of Texas School of Public Health at Houston.

Published in September in Medical Care, considered one of the top journals for health care administrators, the study examines three types of patient trust: trust in physicians, trust in insurers and trust in the medical profession in general. The researchers also address whether the relationship between trust and satisfaction differs according to the type of trust in question, and why overall trust in health care is declining.

“The study is important because there are increasing reports that trust in the medical profession is eroding,” said Rajesh Balkrishnan, Ph.D., associate professor of management and policy sciences at the School of Public Health and principal investigator. “What we have done is identify factors that might show why this is happening.”

The study suggests that demographics such as age, income and health status play only a marginal role in how much a person trusts a doctor or insurer. However, past disputes and long waiting periods during doctor visits play a major role in trust. The study also shows a lower element of trust in foreign-born physicians.

Factors that build trust in the medical profession are uniquely related to options such as a patient’s ability to choose a physician and how much control that physician has in making medical decisions, Balkrishnan said. Patients also focus more on their experience and less on their physician’s characteristics when it comes to trust. People appear to base their attitudes, values and preferences about physicians and insurers on more generalized views about the medical profession.

Researchers conducted a random national telephone survey using validated multi-item measures of trust and satisfaction. A total of 1,117 people age 20 and older who had health insurance took part in the study. The participants also must have visited doctors at least twice in the previous two years.

“Satisfaction, which overlaps with trust, is looking back at the service, whether or not you feel you’ve received good service – trust looks at the future,” Balkrishnan said.

“This information advances our understanding of the nature of trust. Once we know the factors, we may begin working on how to fix the problem, so we can re-build trust and develop more satisfaction.”

Physician trust rates were around 80 percent, while trust in insurers averaged about 70 percent. Seventy-four percent of those surveyed reported having an adequate choice in selecting their physician, while only 31 percent reported having a choice in the selection of their insurer. Having a selection in the choice of the physician and insurer was strongly predictive of increased trust with these two groups.

About 10 percent of the patients reported seeking second opinions on findings by their current physicians, a factor associated with decreased trust in their physician but increased trust in the medical profession.

Nearly 32 percent of the study sample reported having a dispute with their health insurer, while only 15 percent reported having a dispute with their physician. Having a dispute with either physician or insurer was strongly associated with decreased trust in these two groups.

Co-investigators included researchers at the New England Research Institutes and Wake Forest University Health Sciences. The study was supported by the Robert Wood Johnson Foundation.

— By Scott Merville, Public Affairs