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Physicians’ career satisfaction, quality of care and patients’ trust: the role of community uninsurance

Published online by Cambridge University Press:  01 October 2007

JOSÉ A. PAGÁN ,
LAKSHMI BALASUBRAMANIAN  and
MARK V. PAULY
JOSÉ A. PAGÁN*
Affiliation:
Department of Economics and Finance, University of Texas-Pan American, USA
LAKSHMI BALASUBRAMANIAN
Affiliation:
Department of Economics and Finance, University of Texas-Pan American, USA
MARK V. PAULY
Affiliation:
Health Care Systems Department, The Wharton School, University of Pennsylvania, USA
*
*Corresponding author: José A. Pagán, Department of Economics and Finance, College of Business Administration, The University of Texas-Pan American, 1201 W. University Dr. Edinburg, TX 78539, USA. Tel: +1 956-318-5306; Email: [email protected]
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Abstract:

There is evidence that health care providers located in communities with relatively large uninsured populations face financial difficulties because of low service demand and high levels of uncompensated care. Data on 4,920 physicians from the 2000–2001 Community Tracking Study Physician Survey and from 25,637 adults from the 2003 Community Tracking Study Household Survey were used to analyze whether the relative size of the local uninsured population is associated with the level of career satisfaction and the quality of care provided by physicians and to assess whether patient trust is associated with the level of community uninsurance. The results indicate that the proportion of uninsured adults in a given community is negatively related to physicians’ career satisfaction and the perceived quality of health care provided. Community uninsurance is also negatively related to patient trust in their doctor and positively related to whether insured patients believed that their doctor was influenced by rules from health insurance companies. Physicians in communities with relatively large uninsured populations may have lower career satisfaction and lower perceptions of the quality of care provided due to financial difficulties. Patients in these communities are also less likely to trust their physician.

Type
Articles
Information
Health Economics, Policy and Law , Volume 2 , Issue 4 , October 2007 , pp. 347 - 362
Copyright
Copyright © Cambridge University Press 2007

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References

Altice, F. L., Mostashari, F., and Friedland, G. H. (2001), ‘Trust and the acceptance of and adherence to antiretroviral therapy’, Journal of Acquired Immune Deficiency Syndromes (1999), 28(1): 47–58.CrossRefGoogle ScholarPubMed
Center for Studying Health System Change (2003), ‘Community Tracking Study Household Survey, 2000–2001’ [Computer File], 3764, ICPSR Version, Inter-university Consortium for Political and Social Research: Ann Arbor, MI.Google Scholar
Cunningham, P. J. and Kemper, P. (1998), ‘The uninsured getting care: where you live matters’, Issue Brief (Center for Studying Health System Change), Washington, DC: Health System Change.Google Scholar
Cunningham, P. J. (2004), ‘A shared destiny: community effects of uninsurance’, Journal of the American Medical Association, 291(5): 625-a, 626.Google Scholar
DeNavas-Walt, C., Proctor, B. D., and Lee, C. H. (2006), ‘Income, Poverty, and Health Insurance Coverage in the United States: 2005 US Census Bureau, Current Population Reports, P60-231’, Washington, DC: US Government Printing Office.Google Scholar
Diez Roux, A. V. (2001), ‘Investigating neighborhood and area effects on health’, American Journal of Public Health, 91(11): 1783–1789.CrossRefGoogle ScholarPubMed
Haas, J. S., Phillips, K. A., Baker, L. C., Sonneborn, D., and McCulloch, C. E. (2003), ‘Is the prevalence of gatekeeping in a community associated with individual trust in medical care?’, Medical Care, 41(5): 660–668.CrossRefGoogle Scholar
Hadley, J., and Holahan, J. (2003), ‘How much medical care do the uninsured use, and who pays for it?’, Health Affairs, Suppl Web Exclusives,W3, 66–81.Google Scholar
Hall, M. A., Dugan, E., Zheng, B., and Mishra, A. K. (2001), ‘Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?’, The Milbank Quarterly, 79(4): 613–639.CrossRefGoogle ScholarPubMed
Institute of Medicine: Committee on the Consequences of Uninsurance (2002), ‘Insuring health’, Care Without Coverage: Too Little, Too Late, Washington, DC: National Academies Press.Google Scholar
Institute of Medicine: Committee on the Consequences of Uninsurance (2003), A Shared Destiny: Community Effects of Uninsurance, Washington, DC: National Academies Press.Google Scholar
Inter-university Consortium for Political and Social Research (2003), Community Tracking Study Physician Survey, 2000–2001, 3820, ICPSR Version, Inter-university Consortium for Political and Social Research distributor, Ann Arbor, Mich.Google Scholar
Inter-university Consortium for Political and Social Research (2005), Community Tracking Study Household Survey, 2003, ICPSR Version, Inter-university Consortium for Political and Social Research distributor, Ann Arbor, Mich.Google Scholar
Kawachi, I. and Kennedy, B. P. (1999), ‘Income inequality and health: pathways and mechanisms’, Health Services Research, 34(1 Pt 2): 215–227.Google ScholarPubMed
Mollborn, S., Stepanikova, I., and Cook, K. S. (2005), ‘Delayed care and unmet needs among health care system users: when does fiduciary trust in a physician matter?’, Health Services Research, 40(6 Pt 1): 1898–1917.CrossRefGoogle Scholar
Pagán, J. A., and Pauly, M. V. (2006), ‘Community-level uninsurance and the unmet medical needs of insured and uninsured adults’, Health Services Research, 41(3 Pt 1): 788–803.CrossRefGoogle ScholarPubMed
Rabe-Hesketh, S. and Skrondal, A. (2005), Multilevel and Longitudinal Modeling Using Stata, College Station, TX: Stata Press.Google Scholar
Safran, D. G., Taira, D. A., Rogers, W. H., Kosinski, M., Ware, J. E., and Tarlov, A. R. (1998), ‘Linking primary care performance to outcomes of care’, Journal of Family Practice, 47(3): 213–220.Google ScholarPubMed
Skrondal, A. and Rabe-Hesketh, S. (2004), Generalized Latent Variable Modeling: Multilevel, Longitudinal, and Structural Equation Models, Boca Raton, FL: Chapman & Hall/CRC.Google Scholar
Stoddard, J. J., Hargraves, J. L., Reed, M., and Vratil, A. (2001), ‘Managed care, professional autonomy, and income: effects on physician career satisfaction’, Journal of General Internal Medicine, 16(10): 675–684.Google Scholar
Subramanian, S. V., Blakely, T., and Kawachi, I. (2003), ‘Income inequality as a public health concern: where do we stand? Commentary on “Is Exposure to Income Inequality a Public Health Concern?”’, Health Services Research, 38(1p1): 153–167.CrossRefGoogle Scholar
Tanne, J. H. (2006), ‘Number of uninsured middle class US citizens grows’, British Medical Journal, 332(7549): 1047.CrossRefGoogle Scholar
Thom, D. H., Ribisl, K. M., Stewart, A. L., and Luke, D. A. (1999), ‘Further validation and reliability testing of the trust in physician scale: the Stanford Trust Study Physicians’, Medical Care, 37(5): 510–517.CrossRefGoogle ScholarPubMed