The impact of managed care on patients' trust in medical care and their physicians

Social trust in health care organizations and interpersonal trust in may be mutually supportive, but they also diverge in important. The success of medical care depends most importantly on patients' trust their physicians are competent, take appropriate responsibility and, and give their patients' welfare the highest priority. Utilization and structural arrangements in managed care potentially challenge trust physicians by restricting choice, contradicting medical decisions and, and restricting open communication with patients. Gatekeeping and to limit care also raise serious trust issues. We argue that care plans rather than physicians should be required to disclose arrangements, that limits be placed on incentives that put at financial risk, and that professional norms and public policies encourage clear separation of interests of physicians from health plan and finance.