Patel Mitesh S, Chernew Michael E
University of Michigan Medical School, USA.
J Health Polit Policy Law. 2007 Oct;32(5):819-42. doi: 10.1215/03616878-2007-031.
Physician organizations, policy makers, and patient advocates have expressed concern that health plans have contractually limited the freedom of physicians to communicate with their patients. In response, many states have adopted gag laws that limit the ability of managed care contracts to restrict patient-physician communication. We examine the impact of these laws on patient trust in the physician. We analyzed patients' ratings of trust in their physicians in states before and after adoption of gag laws. Individuals in states that had such laws throughout the study period were used as the comparison group. The analysis is based on a nationally representative sample of adults obtained from the 1996-1997 and 1998-1999 Community Tracking Study Household Surveys. After adjustment for patient characteristics, it was estimated that the adoption of gag laws had no statistically significant impact on trust in the physician for the average patient. However, the adoption of gag laws is estimated to have increased trust in the physician by a modest amount (25 percent of a standard deviation) for health maintenance organization (HMO) enrollees who did not have a usual source of care. Gag laws may assure HMO enrollees without a usual source of care that their physicians are free to speak candidly about treatment options. This does not necessarily imply that physicians are prohibited from speaking freely in the absence of such laws, but gag laws indicate concerns (justified or not) that patients have about unrestricted communication with their health care providers.
医生组织、政策制定者和患者权益倡导者对健康计划通过合同限制医生与患者沟通的自由表示担忧。作为回应，许多州通过了限制管理式医疗合同限制医患沟通能力的禁言法。我们研究了这些法律对患者对医生信任度的影响。我们分析了禁言法通过前后各州患者对医生的信任评级。在整个研究期间都有此类法律的州的个人被用作对照组。该分析基于从1996 - 1997年和1998 - 1999年社区追踪研究家庭调查中获得的具有全国代表性的成年人样本。在对患者特征进行调整后，据估计，禁言法的通过对普通患者对医生的信任没有统计学上的显著影响。然而，据估计，禁言法的通过使没有固定医疗服务来源的健康维护组织（HMO）参保者对医生的信任略有增加（标准差的25%）。禁言法可能会让没有固定医疗服务来源的HMO参保者放心，他们的医生可以自由地坦诚谈论治疗选择。这并不一定意味着在没有此类法律的情况下医生被禁止自由发言，但禁言法表明了患者对与医疗服务提供者不受限制的沟通所存在的担忧（无论是否合理）。
