Top

Published in:

01-12-2017 | Health Policy

Public Mistrust of the U.S. Health Care System’s Profit Motives: Mixed-Methods Results from a Randomized Controlled Trial

Authors: Jennifer Richmond, MSPH, Wizdom Powell, PhD, MPH, Maureen Maurer, MPH, Rikki Mangrum, MLS, Marthe R. Gold, MD, MPH, Ela Pathak-Sen, MBA, Manshu Yang, PhD, Kristin L. Carman, PhD

Published in: Journal of General Internal Medicine | Issue 12/2017

Abstract

Background

Decision makers are increasingly tasked with reducing health care costs, but the public may be mistrustful of these efforts. Public deliberation helps gather input on these types of issues by convening a group of diverse individuals to learn about and discuss values-based dilemmas.

Objective

To explore public perceptions of health care costs and how they intersect with medical mistrust.

Design and Participants

This mixed-methods study analyzed data from a randomized controlled trial including four public deliberation groups (n = 96) and a control group (n = 348) comprising English-speaking adults aged 18 years and older. Data were collected in 2012 in four U.S. regions.

Approach

We used data from four survey items to compare attitude shifts about costs among participants in deliberation groups to participants in the control group. We qualitatively analyzed deliberation transcripts to identify themes related to attitude shifts and to provide context for quantitative results about attitude shifts.

Key Results

Deliberation participants were significantly more likely than control group participants to agree that doctors and patients should consider cost when making treatment decisions (β = 0.59; p < 0.01) and that people should consider the effect on group premiums when making treatment decisions (β = 0.48; p < 0.01). Qualitatively, participants mistrusted the health care system’s profit motives (e.g., that systems prioritize making money over patient needs); however, after grappling with patient/doctor autonomy and learning about and examining their own views related to costs during the process of deliberation, they largely concluded that payers have the right to set some boundaries to curb costs.

Conclusions

Individuals who are informed about costs may be receptive to boundaries that reduce societal health care costs, despite their mistrust of the health care system’s profit motives, especially if decision makers communicate their rationale in a transparent manner. Future work should aim to develop transparent policies and practices that earn public trust.

Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307(14):1513-6. https://doi.org/10.1001/jama.2012.362.CrossRefPubMed

Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med 2006;21(4):292-7. https://doi.org/10.1111/j.1525-1497.2006.00396.x.CrossRefPubMedPubMedCentral

Blendon RJ, Benson JM, Hero JO. Public trust in physicians--U.S. medicine in international perspective. N Engl J Med 2014;371(17):1570-2. https://doi.org/10.1056/NEJMp1407373.CrossRefPubMed

Hammond WP, Matthews D, Mohottige D, Agyemang A, Corbie-Smith G. Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. J Gen Intern Med 2010;25(12):1300-8. https://doi.org/10.1007/s11606-010-1481-z.CrossRefPubMedPubMedCentral

LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res 2009;44(6):2093-105. https://doi.org/10.1111/j.1475-6773.2009.01017.x.CrossRefPubMedPubMedCentral

Kannan VD, Veazie PJ. Predictors of avoiding medical care and reasons for avoidance behavior. Med Care 2014;52(4):336-45. https://doi.org/10.1097/mlr.0000000000000100.CrossRefPubMed

Boivin A, Lehoux P, Lacombe R, Burgers J, Grol R. Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. Implement Sci 2014;9:24. https://doi.org/10.1186/1748-5908-9-24.CrossRefPubMedPubMedCentral

Abelson J, Forest P-G, Eyles J, Smith P, Martin E, Gauvin F-P. Deliberations about deliberative methods: issues in the design and evaluation of public participation processes. Soc Sci Med. 2003;57(2):239-51. https://doi.org/10.1016/S0277-9536(02)00343-X.CrossRefPubMed

Carman KL, Maurer M, Mallery C, et al. Community Forum Deliberative Methods Demonstration: evaluating effectiveness and eliciting public views on use of evidence Rockville: Agency for Healthcare Research and Quality; 2014.

10.

Wang G, Gold M, Siegel J, et al. Deliberation: obtaining informed input from a diverse public. J Health Care Poor Underserved 2015;26(1):223-42. https://doi.org/10.1353/hpu.2015.0021.CrossRefPubMed

11.

Carman KL, Mallery C, Maurer M, et al. Effectiveness of public deliberation methods for gathering input on issues in healthcare: results from a randomized trial. Soc Sci Med 2015;133:11-20. https://doi.org/10.1016/j.socscimed.2015.03.024.CrossRefPubMed

12.

Maurer M, Mangrum R, Carman KL, et al. Setting boundaries: public views on limiting patient and physician autonomy in health care decisions. J Health Polit Policy Law. 2017. https://doi.org/10.1215/03616878-3856079.

13.

Carman KL, Maurer M, Mangrum R, et al. Understanding an informed public’s views on the role of evidence in making health care decisions. Health Aff (Millwood). 2016;35(4):566-74. https://doi.org/10.1377/hlthaff.2015.1112.CrossRefPubMed

14.

Carman KL, Heeringa JW, Heil SKR, et al. The use of public deliberation in eliciting public input: findings from a literature review. Rockville: Agency for Healthcare Research and Quality; 2013.

15.

Hsieh H-F, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res 2005;15(9):1277-88. https://doi.org/10.1177/1049732305276687.CrossRefPubMed

16.

Ryan GW, Bernard HR. Techniques to identify themes. Field Methods 2003;15(1):85-109.CrossRef

17.

Fetters MD, Curry LA, Creswell JW. Achieving Integration in Mixed Methods Designs—Principles and Practices. Health Serv Res 2013;48(6 Pt 2):2134-56. https://doi.org/10.1111/1475-6773.12117.CrossRefPubMedPubMedCentral

18.

Miles M, Huberman A. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications; 1994.

19.

Gerber AS, Patashnik EM, Doherty D, Dowling C. The public wants information, not board mandates, from comparative effectiveness research. Health Aff (Millwood). 2010;29(10):1872-81. https://doi.org/10.1377/hlthaff.2010.0655.CrossRefPubMed

20.

Botta MD, Blendon RJ, Benson JM. Cost-effectiveness decision making and US public opinion. JAMA Intern Med 2014;174(1):141-3. https://doi.org/10.1001/jamainternmed.2013.11332.CrossRefPubMed

21.

Sommers R, Goold SD, McGlynn EA, Pearson SD, Danis M. Focus groups highlight that many patients object to clinicians’ focusing on costs. Health Aff (Millwood) 2013;32(2):338-46. https://doi.org/10.1377/hlthaff.2012.0686.CrossRef

22.

Bullock AJ, Hofstatter EW, Yushak ML, Buss MK. Understanding Patients’ Attitudes Toward Communication About the Cost of Cancer Care. J Oncol Pract 2012;8(4):e50-e8. https://doi.org/10.1200/JOP.2011.000418.CrossRefPubMedPubMedCentral

23.

Blendon RJ, Brodie M, Benson JM, Altman DE, Buhr T. Americans’ Views of Health Care Costs, Access, and Quality. Milbank Q. 2006;84(4):623-57. https://doi.org/10.1111/j.1468-0009.2006.00463.x.CrossRefPubMedPubMedCentral

24.

Danis M, Sommers R, Logan J, et al. Exploring Public Attitudes Towards Approaches to Discussing Costs in the Clinical Encounter. J Gen Intern Med 2014;29(1):223-9. https://doi.org/10.1007/s11606-013-2543-9.CrossRefPubMed

25.

Armstrong K, McMurphy S, Dean LT, et al. Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med 2008;23(6):827-33. https://doi.org/10.1007/s11606-008-0561-9.CrossRefPubMedPubMedCentral

26.

Armstrong K, Putt M, Halbert CH, et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care 2013;51(2):144-50. https://doi.org/10.1097/MLR.0b013e31827310a1.CrossRefPubMedPubMedCentral

27.

Martin KD, Roter DL, Beach MC, Carson KA, Cooper LA. Physician communication behaviors and trust among black and white patients with hypertension. Med Care 2013;51(2):151-7. https://doi.org/10.1097/MLR.0b013e31827632a2.CrossRefPubMedPubMedCentral

28.

Shea JA, Micco E, Dean LT, McMurphy S, Schwartz JS, Armstrong K. Development of a revised Health Care System Distrust scale. J Gen Intern Med 2008;23(6):727-32. https://doi.org/10.1007/s11606-008-0575-3.CrossRefPubMedPubMedCentral

29.

Armstrong K, Putt M, Halbert CH, et al. The influence of health care policies and health care system distrust on willingness to undergo genetic testing. Med Care 2012;50(5):381-7. https://doi.org/10.1097/MLR.0b013e31824d748b.CrossRefPubMedPubMedCentral

30.

Greene J, Fuentes-Caceres V, Verevkina N, Shi Y. Who’s aware of and using public reports of provider quality? J Health Care Poor Underserved 2015;26(3):873-88. https://doi.org/10.1353/hpu.2015.0093.CrossRefPubMed

31.

Shah MK, Heisler M, Davis MM. Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda. J Health Care Poor Underserved 2014;25(1):17-24. https://doi.org/10.1353/hpu.2014.0019.CrossRefPubMedPubMedCentral

32.

Martinez J, Ro M, Villa NW, Powell W, Knickman JR. Transforming the delivery of care in the post-health reform era: what role will community health workers play? Am J Public Health 2011;101(12):e1-5. https://doi.org/10.2105/ajph.2011.300335.CrossRefPubMedPubMedCentral

33.

Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer 2011;117(15 Suppl):3543-52. https://doi.org/10.1002/cncr.26264.PubMedPubMedCentral

34.

Viswanathan M, Kraschnewski JL, Nishikawa B, et al. Outcomes and costs of community health worker interventions: a systematic review. Med Care 2010:792-808.

35.

Perry H, Crigler L, Lewin S, Glenton C, LeBan K, Hodgins S. A new resource for developing and strengthening large-scale community health worker programs. Hum Resour Health 2017;15(1):13. https://doi.org/10.1186/s12960-016-0178-8.CrossRefPubMedPubMedCentral

36.

Valaitis RK, Carter N, Lam A, Nicholl J, Feather J, Cleghorn L. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Serv Res 2017;17(1):116. https://doi.org/10.1186/s12913-017-2046-1.CrossRefPubMedPubMedCentral

37.

File T, Ryan C. Computer and Internet use in the United States: 2013. American Community Survey Reports. 2014.

Title: Public Mistrust of the U.S. Health Care System’s Profit Motives: Mixed-Methods Results from a Randomized Controlled Trial
Authors: Jennifer Richmond, MSPH
Wizdom Powell, PhD, MPH
Maureen Maurer, MPH
Rikki Mangrum, MLS
Marthe R. Gold, MD, MPH
Ela Pathak-Sen, MBA
Manshu Yang, PhD
Kristin L. Carman, PhD
Publication date: 01-12-2017
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 12/2017
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4172-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Objective

Design and Participants

Approach

Key Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2017

Eliciting Personal Values of Patients with Multiple Chronic Conditions: Why and How

Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients

Capsule Commentary on O’Malley et al., Providers’ Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study

Pregnancy in Residency

Reliability of Physician-Level Measures of Patient Experience in Primary Care

Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials