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Trust in managed care organizations.

Kennedy Institute of Ethics Journal

|October 20, 2001

Summary

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Managed care may erode patient trust, but merit trust in physicians can be rebuilt. Organizational legitimacy, including fairness and accommodating non-instrumental patient well-being, is key for rebuilding trust in healthcare.

Area of Science:

Medical Ethics
Health Services Research
Organizational Behavior

Background:

Managed care is criticized for eroding patient trust and compromising physician fiduciary duties.
Distinguishes between status trust and merit trust in the physician-patient relationship.

Purpose of the Study:

To evaluate the impact of managed care on patient trust in physicians.
To propose a new framework for establishing merit trust in managed care organizations.
To explore policy implications for fostering competition in healthcare.

Main Methods:

Conceptual analysis distinguishing status and merit trust.
Analogy drawn between managed care organizations and political systems.
Exploration of organizational legitimacy and its components.

Keywords:

Analytical Approach Health Care and Public Health Professional Patient Relationship

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Main Results:

Status trust in physicians may be over-rated; erosion is acceptable if merit trust increases.
Traditional medical ethics alone are insufficient for merit trust under managed care.
Organizational legitimacy, procedural justice, and accommodating non-instrumental patient well-being are crucial for merit trust.

Conclusions:

Managed care requires a redefined basis for patient trust, focusing on organizational legitimacy.
Physician fiduciary obligations can be reconciled with managed care through organization-based merit trust.
Public policy should encourage competition among managed care organizations for merit trust.