Address correspondence to Stefanie Mollborn, M.A., 450 Serra Mall, Building 120, Room 160, Stanford University, Stanford, CA 94305-2047. Irena Stepanikova, M.A., and Karen S. Cook, Ph.D., are with Stanford University, Stanford, CA.
Delayed Care and Unmet Needs among Health Care System Users: When Does Fiduciary Trust in a Physician Matter?
Article first published online: 1 SEP 2005
Health Services Research
Volume 40, Issue 6p1, pages 1898–1917, December 2005
How to Cite
Mollborn, S., Stepanikova, I. and Cook, K. S. (2005), Delayed Care and Unmet Needs among Health Care System Users: When Does Fiduciary Trust in a Physician Matter?. Health Services Research, 40: 1898–1917. doi: 10.1111/j.1475-6773.2005.00457.x
- Issue published online: 1 SEP 2005
- Article first published online: 1 SEP 2005
- Unmet health care needs;
- delayed care;
- utilization of services;
- patient–physician trust;
- barriers to care
Objectives. To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.
Data Sources/Study Setting. The 1998–1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care (n=29,994).
Study Design. We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.
Principal Findings. Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.
Conclusions. Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.