Development of a scale to measure patients' trust in health insurers.

OBJECTIVE To develop a scale to measure patients' trust in health insurers, including public and private insurers and both indemnity and managed care. A scale was developed based on our conceptual model of insurer trust. The scale was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. DATA SOURCES/STUDY SETTING The scale was developed and validated on a random national sample (n = 410) of subjects with any type of insurance and further validated and used in a regional random sample of members of an HMO in North Carolina (n = 1152). STUDY DESIGN Factor analysis was used to uncover the underlying dimensions of the scale. Internal consistency was assessed by Cronbach's alpha. Construct validity was established by Pearson or Spearman correlations and t tests. DATA COLLECTION Data were collected via telephone interviews. PRINCIPAL FINDINGS The 11-item scale has good internal consistency (alpha = 0.92/ 0.89) and response variability (range = 11-55, M = 36.5/37.0, SD = 7.8/7.0). Insurer trust is a unidimensional construct and is related to trust in physicians, satisfaction with care and with insurer, having enough choice in selecting health insurer, no prior disputes with health insurer, type of insurer, and desire to remain with insurer. CONCLUSIONS Trust in health insurers can be validly and reliably measured. Additional studies are required to learn more about what factors affect insurer trust and whether differences and changes in insurer trust affect actual behaviors and other outcomes of interest.

[1]  A M Zaslavsky,et al.  The relationship between method of physician payment and patient trust. , 1998, JAMA.

[2]  J. Ware.  Effects of Acquiescent Response Set on Patient Satisfaction Ratings , 1978, Medical care.

[3]  S. Goold.  Money and trust: relationships between patients, physicians, and health plans. , 1998, Journal of health politics, policy and law.

[4]  Bernard Barber,et al.  The Logic and Limits of Trust , 1983 .

[5]  J. H. Davis,et al.  An Integrative Model Of Organizational Trust , 1995 .

[6]  T. Govier.  Social trust and human communities , 1997 .

[7]  Gretchen M. Spreitzer,et al.  Explaining How Survivors Respond to Downsizing: The Roles of Trust, Empowerment, Justice, and Work Redesign , 1998 .

[8]  Arnold M. Epstein,et al.  Older Patients' Health Status and Satisfaction With Medical Care in an HMO Population , 1990, Medical care.

[9]  A. Baier,et al.  Moral Prejudices: Essays on Ethics , 1994 .

[10]  Trudy Govier,et al.  Dilemmas of Trust , 1998 .

[11]  A. Baier.  Trust and Antitrust , 1986, Ethics.

[12]  E. McGlynn,et al.  Part 2: Measuring Quality of Care , 1996 .

[13]  D. Mechanic,et al.  The functions and limitations of trust in the provision of medical care. , 1998, Journal of health politics, policy and law.

[14]  D. Mechanic,et al.  Changing medical organization and the erosion of trust. , 1996, The Milbank quarterly.

[15]  D. Mechanic,et al.  Public trust and initiatives for new health care partnerships. , 1998, The Milbank quarterly.

[16]  P. Farley.  Who are the underinsured? , 1985, The Milbank Memorial Fund quarterly. Health and society.

[17]  E. A. Haggard,et al.  FAITH, TRUST AND GULLIBILITY. , 1963, The International journal of psycho-analysis.

[18]  J E Ware,et al.  The Primary Care Assessment Survey: tests of data quality and measurement performance. , 1998, Medical care.

[19]  Robert F. Dedrick,et al.  Development of the Trust in Physician Scale: A Measure to Assess Interpersonal Trust in Patient-Physician Relationships , 1990, Psychological reports.

[20]  Roderick M. Kramer,et al.  Trust and distrust in organizations: emerging perspectives, enduring questions. , 1999, Annual review of psychology.

[21]  M. Foddy,et al.  Trust and the Consumption of a Deteriorating Common Resource , 1987 .

[22]  R. Blendon,et al.  Understanding the managed care backlash. , 1998, Health affairs.

[23]  Rogers De.  On trust: a basic building block for healing doctor-patient interactions. , 1994 .