title: Development of a scale to measure patients' trust in health insurers.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  Data were collected via telephone interviews.
  
  
  RESULTS
  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.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
authors.forename: Beiyao
authors.initials: B
authors.lastname: Zheng
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hall
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dugan
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Kidd
authors.forename: Douglas
authors.initials: D
authors.lastname: Levine
mesh_terms: D000328:Adult; D005260:Female; D019538:Health Care Surveys / Q000295:instrumentation*; D006279:Health Maintenance Organizations / Q000145:classification / Q000592:standards*; D006801:Humans; D007343:Insurance Carriers / Q000145:classification / Q000592:standards*; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011594:Psychometrics; D011795:Surveys and Questionnaires