From 1998 to 2000, researchers at Wake Forest University School of Medicine led by Mark A. Hall, JD, developed three survey instruments to measure patient trust in their physicians and subsequently used these instruments to examine how that trust changes after HMOs disclose the financial incentives they offer physicians.

The project was part of the Robert Wood Johnson Foundation (RWJF) Strengthening the Patient-Provider Relationship in a Changing Health Care Environment national program.

Key Findings: Among the investigators' key findings, as reported in the peer-reviewed journals Health Services Research, Medical Care Research and Review and Health Affairs, are the following:

• Patients do not distinguish between trusting physicians generally and trusting their individual physician about particular attributes such as honesty, confidentiality and competency.
• Disclosure of financial incentives by HMOs is now widespread, but the content of current disclosures is excessively legalistic, and fails to convey the purposes of financial incentives and their potential positive and negative consequences.
• The protocol for disclosing financial incentives developed by the study team doubled the level of knowledge among plan members about HMO financial incentives and their potential effects.
• The disclosure of financial incentives to HMO members did not lower trust in primary care physicians or in the HMO. For members whose primary care physicians were paid a capitated rate (a flat rate to provide care for each enrolled patient), disclosure resulted in increased trust in the primary care physician.