Goold Susan Dorr, Fessler David, Moyer Cheryl A
Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0429, USA.
Health Serv Res. 2006 Feb;41(1):58-78. doi: 10.1111/j.1475-6773.2005.00456.x.
Patient-centered assessments are increasingly important. Patients repeatedly emphasize the importance of trust in health care institutions and personnel.
(1) Develop a conceptual framework for trust in health care organizations and a comprehensive, reliable measure of trust in health insurers. (2) Examine predictors and correlates of trust in insurers.
A conceptual framework for trust in health organizations based on theory and empirical studies was used to develop items for a structured telephone survey, which also included measures of health and utilization, doctor-patient trust, and satisfaction with care. Principal components factor analyses identified hypothesized domains of trust in health insurers and identified items for scales. Internal consistency assessment used Cronbach's alpha. Univariate analyses used Pearson's r or Student's t-tests.
Insured residents of Southeastern Michigan (n=400).
Respondents were diverse in age, gender, ethnicity, health, and socioeconomic status. One dominant factor (eigenvalue>10) included hypothesized domains: administrative competence, clinical competence, advocacy and beneficence, fairness, honesty and openness, and one global item. Multidimensional scales were reliable (long version 13 items, alpha=0.95, short: 9 items, alpha=0.91). Insurer trust correlated strongly with trust in doctors (r=0.49 and 0.46) and satisfaction with care (r=0.70 and 0.66), and with an item assessing overall worry about health insurance (r=-0.37 and -0.35). Those with less trust in their insurer were more likely to say that they would change insurance plans (p<.001).
This well-grounded, reliable measure of enrollee trust in insurers can be a useful patient-centered assessment tool.
以患者为中心的评估日益重要。患者反复强调信任医疗机构和医护人员的重要性。
（1）建立一个关于对医疗保健组织信任的概念框架，以及一种全面、可靠的对健康保险公司信任的测量方法。（2）研究对保险公司信任的预测因素和相关因素。
基于理论和实证研究的对健康组织信任的概念框架被用于开发结构化电话调查的项目，该调查还包括健康和利用情况、医患信任以及护理满意度的测量。主成分因子分析确定了对健康保险公司信任的假设领域，并确定了量表项目。内部一致性评估使用克朗巴哈系数。单变量分析使用皮尔逊相关系数r或学生t检验。
密歇根州东南部的参保居民（n = 400）。
受访者在年龄、性别、种族、健康状况和社会经济地位方面各不相同。一个主导因子（特征值>10）包括假设领域：行政能力、临床能力、倡导与慈善、公平、诚实与开放，以及一个总体项目。多维量表是可靠的（长版本13项，α = 0.95，短版本：9项，α = 0.91）。对保险公司的信任与对医生的信任（r = 0.49和0.46）、护理满意度（r = 0.70和0.66）以及一项评估对医疗保险总体担忧的项目（r = -0.37和-0.35）密切相关。对保险公司信任度较低的人更有可能表示他们会更换保险计划（p <.001）。
这种有充分依据、可靠的参保人对保险公司信任度的测量方法可以成为一种有用的以患者为中心的评估工具。
