High Medical Cost Burdens, Patient Trust, and Perceived Quality of Care
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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.
KEY WORDSmedical cost burden patient trust perceived quality of care
Support for this research was provided by the Commonwealth Fund. The author would like to thank Ann O’Malley, M.D., and Sara Collins, Ph.D., for their helpful comments on an earlier draft of this manuscript.
Conflict of Interest
The author asserts that there are no known conflicts of interest regarding the conduct or outcome of this research. The author is employed by the Center for Studying Health System Change, which is a subsidiary of Mathematica Policy Research, Inc., a for-profit company with an Employee Stock Ownership Plan.
- 2.Banthin J, Cunningham P, Bernard D. Trends in the financial burden of health care expenditures, 2001-2004. Health Affairs (forthcoming).Google Scholar
- 3.May JH, Cunningham P. Tough Tradeoffs: Medical Bills, Family Finances and Access to Care. Issue Brief #85. Washington, D.C: Center for Studying Health System Change (2004) Available at http://www.hschange.org/CONTENT/689/. (accessed November 9, 2008).
- 4.Collins SR, Kriss JL, Davis K, Doty MM, Holmgren AL. Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families. [Commonwealth Fund website]: Available at http://www.cmwf.org/usr_doc/Collins_squeezedrisinghltcarecosts_953.pdf. (accessed November 9, 2008).
- 5.Employee Benefit Research Institute. 2006 Health confidence survey: Dissatisfaction with health care system doubles since 1998. [EBRI web site] http://www.ebri.org/pdf/notespdf/EBRI_Notes_11-20061.pdf. Accessed November 9, 2008).
- 10.Beal AC, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the Divide: How Medical Homes Promote Equity in Health Care: Results from the Commonwealth Fund 2006 Health Quality Survey. Available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=506814. Accessed November 9, 2008.
- 17.Strouse R, Carlson BL, Hall J. Community Tracking Study: Household Survey Methodology Report 2003 (Round 4). Technical Publication No. 62. Washington, D.C: Center for Studying Health System Change. Available at: http://www.hschange.org/CONTENT/757/757.pdf. Accessed November 9, 2008.
- 18.Shah BV, Barnwell BG, Bieler FS. SUDAAN User’s Manual, Release 7.0. Research Triangle Park, NC: Research Triangle Institute Inc; 1996.Google Scholar
- 19.Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psych Rep. 1990;67:1091-100.Google Scholar
- 20.Ku L, Coughlin TA. Sliding-scale premium health insurance programs: four states’ experiences. Inquiry. 1999/2000:36;471-80.Google Scholar
- 22.Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: findings from a 2003 national survey. Health Affairs, 2005 (Web Exclusive): W5-152-W5-156.Google Scholar