People love their doctors. Study after study has shown this to be true. Typically 75%-95% of patients surveyed claim that they completely or mostly trust their physician. Does this finding hold even when doctors are compensated through a capitation method and have a financial incentive to withhold care? A study by Kao, et al. (1998) shows that even capitation patients largely trust their doctor. The authors find 94% of FFS indemnity patients, 85% of managed FFS patients, 83% of salary patient patients and 77% of capitated patients trust their doctor.
A study by Hall et al. used a randomized trial where half of HMO patients were explicitly informed that their doctors were compensated on a capitation basis and had a financial incentive to withhold services. These disclosures were found to have no negative effects on the trust of either physicians or insurers. The authors conclude that “once patients have formed opinions of their physicians based on actual experience with them, information about payment methods has little or no effect on their opinions, possibly because of the cognitive dissonance that otherwise would arise.” It would be interesting to examine whether a doctor’s actual proficiency or the doctor’s personality mattered more to the patient in terms of their level of trust.
Hall; Dugan; Balkrishnan; Bradley; (2002) “How disclosing HMO physician incentives affects trust” Health Affairs, March/April, pp. 197-206.
Kao; Green; Zaslavsky; Koplan; Cleary; (1998) “The relationship between method of physician payment and patient trust” JAMA, Vol 280, No. 19, pp. 1708-1714.