MONEY AND TRUST - RELATIONSHIPS BETWEEN PATIENTS, PHYSICIANS, AND HEALTH PLANS

In response to three articles on managed care by Alien Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligation s of those relationships. Trust in managed care organizations (provide rs of and payers for health care) stands in stark contrast to the curr ent contractual model of health insurance purchase, but is more cohere nt with consumer expectations and with the provider role of such organ izations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for t heir impact on both kinds of trust according to their intrusiveness, o penness, and goals. Although involving managed carl enrollees in value -laden decisions that affect them is commendable, restrictions on or r egulation of physician incentive systems may be better accomplished on a national level.