A relationship maintenance model: A comparison between managed health care and traditional fee-for-service

Abstract This article proposes and tests a model of the patient-physician relationship maintenance process. The model is based on constructs from social exchange theory and Rusbult's investment model. A patient's commitment to their relationship with their physician is conceptualized based on a three-component model of commitment. The three components of commitment (affective, continuance, and obligation commitment) are examined in an interpersonal setting. A general model of the patient-physician relationship maintenance process is first tested. Then the model is tested separately on a traditional fee-for-service subsample and a managed health care subsample (HMO, PPO). The results indicate that the relationship maintenance process is different in the traditional fee-for-service group than the managed health care group. Specifically, affective commitment is more important for traditional fee-for-service patients and satisfaction and continuance commitment are more important for managed health care patients.

[1]  Van Matre Jg,et al.  Deepening the understanding of hospital patient satisfaction: fulfillment and equity effects. , 1985 .

[2]  M. Hays.  Consumers base quality perceptions on patient relations, staff qualifications. , 1987, Modern healthcare.

[3]  James C. Anderson,et al.  STRUCTURAL EQUATION MODELING IN PRACTICE: A REVIEW AND RECOMMENDED TWO-STEP APPROACH , 1988 .

[4]  Coile Rc,et al.  Review of 1992 predictions: an .850 average on forecasts. , 1993 .

[5]  Patient loyalty to physicians. , 2008, Journal of health care marketing.

[6]  Michael Jenkins,et al.  Organisational Commitment and Job Satisfaction as Predictors of Employee Turnover Intentions , 1992 .

[7]  James L. Price,et al.  The determinants of employee absenteeism: An empirical test of a causal model* , 1989 .

[8]  Robert C. Ford,et al.  Two (or more?) dimensions of organizational commitment: Reexamination of the affective and continuance commitment scales. , 1987 .

[9]  C. Rusbult,et al.  IMPACT OF EXCHANGE VARIABLES ON EXIT, VOICE, LOYALTY, AND NEGLECT: AN INTEGRATIVE MODEL OF RESPONSES TO DECLINING JOB STATUS SATISFACTION. , 1988 .

[10]  Murphy A. Sewall.  Relative Information Contributions of Consumer Purchase Intentions and Management Judgment as Explanators of Sales , 1981 .

[11]  John P. Meyer,et al.  Commitment to organizations and occupations: Extension and test of a three-component conceptualization. , 1993 .

[12]  K. Jöreskog.  Statistical analysis of sets of congeneric tests , 1971 .

[13]  B. McNeil,et al.  Patient satisfaction as an indicator of quality care. , 1988, Inquiry : a journal of medical care organization, provision and financing.

[14]  T. C. Smith,et al.  The inherent, powerful therapeutic value of a good physician-patient relationship. , 1993, Psychosomatics.

[15]  John M. Jermier,et al.  Effects of Continuance, Affective, and Moral Commitment on the Withdrawal Process: an Evaluation of Eight Structural Equation Models , 1993 .

[16]  F. Reichheld.  Loyalty-based management. , 1993, Harvard business review.

[17]  J E Ware,et al.  Defining and measuring patient satisfaction with medical care. , 1983, Evaluation and program planning.

[18]  T A Fisk,et al.  Creating patient satisfaction and loyalty. , 1990, Journal of health care marketing.

[19]  S. Zyzanski,et al.  Patient satisfaction with the clinical encounter: social psychological determinants. , 1987, Social science & medicine.

[20]  P Batalden,et al.  Do patient perceptions of quality relate to hospital financial performance? , 1992, Journal of health care marketing.

[21]  N. Aranya,et al.  A Comparison of Two Organizational Commitment Scales. , 1983 .

[22]  I. Altman,et al.  Social penetration: The development of interpersonal relationships , 1973 .

[23]  J. Mccombs,et al.  Do HMOs reduce health care costs? A multivariate analysis of two Medicare HMO demonstration projects. , 1990, Health services research.

[24]  J. Sheth,et al.  Relationship marketing in consumer markets: Antecedents and consequences , 1995 .

[25]  J Singh.  A multifacet typology of patient satisfaction with a hospital stay. , 1990, Journal of health care marketing.

[26]  T. DeCotiis,et al.  A Path Analysis of a Model of the Antecedents and Consequences of Organizational Commitment , 1987 .

[27]  D. Ford.  The Development of Buyer‐Seller Relationships in Industrial Markets , 1980 .

[28]  Y. Wiener.  Commitment in Organizations: A Normative View , 1982 .

[29]  Fincham Je,et al.  Predictors of patient satisfaction in a health maintenance organization. , 1986 .

[30]  Gabel Ll,et al.  Why do patients continue to see the same physician , 1993 .

[31]  John P. Meyer,et al.  The measurement and antecedents of affective, continuance and normative commitment to the organization , 1990 .

[32]  J. McAlexander,et al.  Service quality measurement. , 1994, Journal of health care marketing.

[33]  C. Rusbult,et al.  A Longitudinal Test of the Investment Model: The Impact on Job Satisfaction, Job Commitment, and Turnover of Variations in Rewards, Costs, Alternatives, and Investments , 1983 .

[34]  G. W. Rimler,et al.  The ethical impacts of managed care , 1993, Journal of business ethics : JBE.

[35]  Caryl E. Rusbult,et al.  Satisfaction and commitment in friendships. , 1980 .

[36]  H. Kelley,et al.  The social psychology of groups , 1960 .

[37]  Caryl E. Rusbult,et al.  Exchange variables as predictors of job satisfaction, job commitment, and turnover: The impact of rewards, costs, alternatives, and investments. , 1981 .

[38]  S. Hunt,et al.  The Commitment-Trust Theory of Relationship Marketing , 1994 .

[39]  J. Steenkamp,et al.  The Effects of Supplier Fairness on Vulnerable Resellers , 1995 .