Is the prevalence of gatekeeping in a community associated with individual trust in medical care?
BACKGROUND
Consumer concerns about the restrictions of managed care may lead to distrust.


OBJECTIVE
To examine whether a community's level of gatekeeping activity is associated with an individual's trust in medical care.


METHODS
Cross-sectional cohort (N = 49,929).


METHODS
Participants in a nationally representative sample derived from the Community Tracking Survey who had health insurance, had a usual source of care, made at least 1 physician visit, and resided in one of the sampled metropolitan areas with corresponding community-level data, including the prevalence of gatekeeping activity.


METHODS
Four questions measuring trust in physician.


RESULTS
Individuals from communities with a higher prevalence of gatekeeping activity report less trust than individuals from areas with a lower prevalence of gatekeeping activity, after adjusting for whether that individual had a health plan with a gatekeeper requirement. For example, in communities with the highest prevalence of gatekeeping activity relative to the lowest, the odds ratio for individuals to agree strongly that they trusted their doctor to put their medical needs above all other considerations was 0.77 (95% confidence interval, 0.71-0.84). Also, a higher prevalence of gatekeeping in the community was positively associated with the perception that a physician was strongly influenced by insurance company rules when making decisions about medical care. Conversely, a higher prevalence of gatekeeping in the community was negatively associated with the perception that a doctor might perform an unnecessary test or procedure and with concern about restricted referral for specialty care.


CONCLUSIONS
Individuals' trust in their physicians may be influenced by wider contextual variables, like the prevalence of gatekeeping in the community.
Institute for Health Policy Studies, University of California, San Francisco, USA. jhaas@partners.org
Jennifer S
JS
Haas
Kathryn A
KA
Phillips
Laurence C
LC
Baker
Dean
D
Sonneborn
Charles E
CE
McCulloch
D000328:Adult; D001294:Attitude to Health / Q000208:ethnology; D015331:Cohort Studies; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D020793:Gatekeeping / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D010817:Physician-Patient Relations; D012111:Residence Characteristics; D035502:Trust; D014481:United States