The impact of managed care on patients' trust in medical care and their physicians
The impact of managed care on patients' trust in medical care and their physicians
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DOI：
10.1001/jama.275.21.1693
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发表时间：
1996-06-05
影响因子：
120.7
通讯作者：
Schlesinger, M
中科院分区：
文献类型：
--
作者：
Mechanic, D;Schlesinger, M
社会信任的医疗保健组织和人际信任的医生可能是相互支持的，但他们也有分歧的重要方式。医疗护理的成功最重要的是取决于患者对医生的信任，他们的医生是有能力的，承担适当的责任和控制，并给予他们的患者的福利最高的优先权，管理式护理中的使用审查和结构安排可能会通过限制选择，与医疗决策和控制相矛盾，以及限制与患者的公开沟通，守门和激励措施，以限制医疗也提出了严重的信任问题，我们认为，管理式医疗计划，而不是医生应该被要求披露财务安排，限制激励措施，使医生在财务风险，专业规范和公共政策应鼓励将医生的利益与健康计划组织和财务明确分开。
Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority, Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients, Gatekeeping and incentives to limit care also raise serious trust issues, We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance.