Trust Me: Technical and Institutional Determinants of Health Maintenance Organizations Shifting Risk to Physicians

Sleeper, Sally; Wholey, Douglas R.; Hamer, Richard; Schwartz, Shawn; Inoferio, Vito

doi:10.2307/2676312

Cited by 10 publications

(6 citation statements)

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“…One study did claim to find indirect evidence of greater consumer distrust in forprofit health plans. Sleeper et al (1998) established that for-profit plans were less likely than their nonprofit counterparts to make use of capitation payments to physicians. Because these sorts of financial incentives arouse fears among consumers (Miller and Horowitz 2000), the researchers concluded that for-profit plans could not afford to use them, because of ''consumer distrust of for-profit HMOs'' (p. 189).…”

Section: Acknowledgmentsmentioning

confidence: 99%

Profit‐Seeking, Corporate Control, and the Trustworthiness of Health Care Organizations: Assessments of Health Plan Performance by Their Affiliated Physicians

Schlesinger

Quon²,

Wynia³

et al. 2005

Health Services Research

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Objective. To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. Data Source. A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Study Design. Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. Data Collection. The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Principal Findings. Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than locally controlled nonprofits on two of the five measures. The magnitude of these ownership-related differences declines as the market share of 605

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Section: Acknowledgmentsmentioning

confidence: 99%

Profit‐Seeking, Corporate Control, and the Trustworthiness of Health Care Organizations: Assessments of Health Plan Performance by Their Affiliated Physicians

Schlesinger

Quon²,

Wynia³

et al. 2005

Health Services Research

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“…A recent survey suggests that patients enrolled in ''heavy managed care" are particularly uncertain about the response of their health plans to any needs that might arise: 34 percent of respondents in traditional plans and 61 percent in ''heavy managed care" were either very, or somewhat, worried that their health plan would be more concerned with saving money than with devising the best treatment for them when they are sick (Blendon et al 1998). This high level of uncertainty makes trust building a rational organizational strategy for MCOs (Sleeper, Wholey, Hamer, et al 1998). Although trust in one's physician is largely determined by personal experience over time, trust in large organizations and institutions tends to be shaped by media attention and public discourse.…”

Section: The Concept Of Trustmentioning

confidence: 99%

Responses of HMO Medical Directors to Trust Building in Managed Care

Mechanic

Rosenthal

1999

Milbank Quarterly

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Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations' strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring family and patient support groups. The responses obtained from 252 directors indicate that nonprofit and free-standing organizations are more likely than either for-profit HMOs or organizations that are part of a chain to sponsor community activities and programs and to offer family and patient support groups. Staff- and group-model HMOs are more likely than other organizational configurations to initiate many types of "trust programs." The results indicate that more dispersed and "virtual-type" organizations must explore ways to respond meaningfully to community concerns--and to public health, prevention, and health promotion needs as well--while continuing to improve their practice patterns.

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“…In medicine, patients’ overwhelming need to trust their physicians and the resultant refusal of care when trust is lost is noted (Sherlock 1986). The importance of individuals’ interpersonal trust in physicians and the impact of social trust (or mistrust) in health care organizations is also discussed (Mechanic & Schlesinger 1996, Gray 1997, Mechanic 1997, Goold 1998, Sleeper et al. 1998, Grumbach et al.…”

Section: Resultsmentioning

confidence: 99%

“…In medicine, patients' overwhelming need to trust their physicians and the resultant refusal of care when trust is lost is noted (Sherlock 1986). The importance of individuals' interpersonal trust in physicians and the impact of social trust (or mistrust) in health care organizations is also discussed (Mechanic & Schlesinger 1996, Gray 1997, Mechanic 1997, Goold 1998, Sleeper et al 1998, Grumbach et al 1999, Cleary et al 1999. Trust is de®ned as`the expectations of the public that those who serve them will perform their responsibilities in a technically pro®cient way (competence), that they will assume responsibility and not inappropriately defer to others (control), and that they will make their patients' welfare their highest priority (agency)' (Mechanic & Schlesinger 1996, p. 1693.…”

Section: Medicinementioning

confidence: 99%