Health Policy

Journal of General Internal Medicine

, Volume 24, Issue 3, pp 415-420

First online:

High Medical Cost Burdens, Patient Trust, and Perceived Quality of Care

  • Peter J. CunninghamAffiliated withCenter for Studying Health System Change Email author 

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The financial burden of medical care expenses is increasing for American families. However, the association between high medical cost burdens and patient trust in physicians is not known.


To examine the association between high medical cost burdens and self-reported measures of patient trust and perceived quality of care.


Cross-sectional household survey based on random-digit dialing and conducted largely by telephone, supplemented by in-person interviews of households with no telephones. The sample for this analysis includes 32,210 adults who reported having a physician as their regular source of care. Measures of patient trust include overall trust, confidence in being referred to a specialist, and belief that the physician uses more services than necessary. Perceived quality measures include thoroughness of exam, ability to listen, and ability to explain.


In adjusted analyses, persons with high medical cost burdens had greater odds of lacking trust in their physician to put their needs above all else (OR = 1.43, CI = 1.19, 1.73), not referring them to specialists (OR = 1.39, CI = 1.22, 1.58), and performing unnecessary tests (OR = 1.42, CI = 1.20, 1.62). Patients with high medical cost burdens also had more negative assessments of the thoroughness of care they receive from their physician (OR = 1.26, CI = 1.02, 1.56). The association of high medical cost burdens with patient trust and perceived quality of care was greatest for privately insured persons.


The rising cost of medical care threatens a vital aspect of the effective delivery of medical care–patient trust in their physician and continuity of care. Exposing patients to more of the costs could lead to greater skepticism and less trust of physicians’ decision-making, thereby making health-care delivery less effective.


medical cost burden patient trust perceived quality of care