Mistrust of healthcare system could harm patients' health and raise overall health care costs

Sep 2 2009

Mistrust among patients, providers and insurers could harm patients' health and raise overall health care costs, reports a new study.

"Over the last 15 years, the health care system has changed, and increasingly patients' interactions are with the system, not just an individual doctor. We found that persons who were more mistrustful of the health care system were more likely to delay needed care or postpone receiving care, even when they perceived they needed it," said lead author Thomas LaVeist, Ph.D.

LaVeist is director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health. The study appears in the latest issue of Health Services Research online.

Using a 17-question phone survey, the researchers asked 401 primarily African-American Baltimore residents about their use and trust of health care services. Patients who had doubts about the provision of medical care were more likely to fail to take medical advice, fail to keep a follow-up medical appointment and fail to fill a prescription. Less-trusting patients also reported that they were more likely to postpone necessary medical care.

"Mistrust of the health care system leads to patients delaying treatment, so when they do enter into the health care system, they're encountering the system when they're further along and more expensive and difficult to treat," LaVeist said.

In addition, distrust of the system increases the likelihood of malpractice and decreases adherence to treatment plans, since these patients might be less likely to follow medical advice. These issues could lead to worse outcomes for patients and increased costs, LaVeist said.

The author's conclusions about patient suspiciousness and racial disparities are consistent with results from previous research, said Chanita Hughes Halbert, Ph.D., of the Penn Center for Population Health and Health Disparities at the University of Pennsylvania.

"However, as noted by the investigators, they were not able to examine the effects of mistrust on health care utilization within each racial group," Halbert said

"Ultimately we need to deal with this trust issue by training providers as well as others who encounter patients. This is a health system problem, and we need to find ways to make patients more trusting of health care institutions in general. The next step is determining what ways we can engender more trust among patients," LaVeist said.

The study authors received support from the Agency for Healthcare Research and Quality, the Russell Sage Foundation and the National Center on Minority Health and Health Disparities.

http://www.jhsph.edu/