HMOs and Patient Trust in Physicians:

Patients in health maintenance organizations (HMOs) often trust their physicians less than those with other forms of insurance coverage. Recent studies have reported a backlash of criticism against managed care, especially HMOs. In response to this, some have argued that managed care has become more responsive to patients’ wishes. We use data from the Community Tracking Study (CTS) Household Survey 1996-2003 and investigate whether HMOs have made progress in improving patient trust in physicians. We construct and compare a patient trust index among four health insurance types: non-HMO private insurance, HMO private insurance, public insurance, and uninsured. Ordinary least squares (OLS) estimation is used to examine the effects of each insurance type on the patient trust index, adjusting for confounding variables. HMOs have steadily improved patient trust in physicians from 1996 to 2003, although the patient trust index of private HMO enrollees remained lower than that of private non-HMO insured people. Among the four insurance types examined, only HMOs enhanced patient trust during this period. The growth in trust over time among patients in HMOs and the decline in the adverse effects of HMOs on patient trust over time point to improved relationships between HMO physicians and their patients.