Consumer satisfaction with primary care provider choice and associated trust

BACKGROUND: Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust. METHODS: A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≥ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. RESULTS: Results affirmed 'satisfaction with amount of PCP choice' was significantly (p < .001) associated with provider trust. 'PCP's care being extremely effective' was strongly associated with 'satisfaction with amount of PCP choice' and 'provider trust'. Having sought a second opinion(s) was associated with lower trust. 'Spoke to the PCP outside the medical office,' 'satisfaction with the insurer' and 'insurer charges less if PCP within network' were all variables associated with 'satisfaction with amount of PCP choice' (all p < .05). CONCLUSION: This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.

A descriptive analysis of average productivity among health maintenance organizations, 1985 to 2001

This paper examines the evolution of average productivity among HMOs for 4,419 Health Maintenance Organizations (HMOs) from 1985 to 2001. For both IPA and non-IPA HMOs, HMO productivity increased from 1990 to 1996 and rapidly decreased from 1997 to 2001. In contrast to cost functions that show scale economies for IPA and non-IPA HMOs, production functions showed scale economies for IPA HMOs were constant and non-IPA HMOs having only slight scale economies. This suggests that much of the scale economies observed in cost functions are due to lower prices for resources used rather than improvements in production organization. Non-IPA HMOs and non-profit HMOs are more productive than IPA HMOs and for profit HMOs. Production organization for non-IPA HMOs appears to have improved over time, resulting in non-IPA HMOs being able to produce more member months of coverage with their production organization in 1997 to 2001 than they would have with their production organization in 1985 to 1990. Regulations requiring consumer involvement in HMO governance reduce productivity. Copyright Springer Science + Business Media, Inc. 2006Health maintenance organizations, Managed care, Productivity,

Ontwikkeling van een serious game voor multidisciplinaire samenwerking in zorg en welzijn

Gemeenten en zorgorganisaties kijken steeds vaker over grenzen van sectoren heen vanwege de decentralisatie van ondersteuning aan langdurig zieken en ouderen. De samenwerking bij een dergelijke integrale aanpak kent verschillende uitdagingen, die in opleiding en training kunnen worden geoefend. Dit artikel beschrijft het proces om te komen tot een serious game voor het oefenen van de belangrijkste uitdagingen bij complexe multidisciplinaire samenwerking in zorg en welzijn. Op basis van literatuuronderzoek en interviews met professionals zijn vier leerdoelen opgesteld: het onderscheiden van de meerwaarde van de verschillende professionals, het communiceren met de verschillende professionals, het ontwikkelen van en het handelen naar een teamgerichte focus en het reflecteren op de samenwerking en de eigen rol hierin. In een prototype van de serious game combineerden we deze leerdoelen met gaming elementen, zoals tijdsdruk, het omgaan met tegenstrijdige belangen, het uitwisselen van unieke informatie, cross-training en stapsgewijze spelacties. De game is in drie pilotsessies gespeeld met professionals uit zorg en welzijn. Direct na het spelen werd met behulp van een evaluatieprotocol de game geëvalueerd en aangepast. De leerdoelen werden herkend en de spelvorm sluit aan bij de wensen van de praktijk. Deze studie biedt inzicht in de bouwstenen om multidisciplinaire samenwerking te optimaliseren en laat zien hoe een laagdrempelige, praktijkgerichte simulatietraining kan worden ontwikkeld