"The findings are based on a controlled study that observes the real-world impact on trust of telling HMO members how the health plan actually pays its doctors," said the research team headed by Mark Hall, J.D., professor of law and public health.

"We found that learning about cost containment incentives did not reduce people's trust either in their doctor or in the HMO," Hall said. "In fact, this slightly increased trust in their doctor."

The researchers said the result may be a consequence both of displaying candor and of increased understanding of the positive features of the health plans.

The study involved 1,918 participants in two different health care plans. One paid primary care doctors on a capitation basis -- the same amount for each enrolled patient each year, regardless of the number of doctor visits. The other plan paid doctors on a discounted fee for service schedule. Both plans paid bonuses based on meeting budgetary goals, maintaining patient satisfaction, and encouraging patients to use preventive services.

Both before and after disclosing the physician incentives, all participants were asked a series of trust questions about their primary care doctor and about their HMO, as well as questions about past experiences with their doctor and the HMO. After the first series of trust questions, participants were randomly assigned to groups. Disclosure groups were explicitly told how their HMO pays their primary care physician; control groups got no additional information.

Then, a month later, the battery of trust questions was repeated.

Disclosure of the incentives was associated with a 1.4 percent increase in average physician
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Contact: Robert Conn
rconn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
12-Mar-2002