Economic Constraints, Trust and Evolving Patient-Provider Relationships

Award Year:
David Mechanic
Ethical Dilemmas and Resource Allocation, Physician-Patient Relationship
The public's trust in physicians is an essential aspect of health care delivery. As tensions grow between new medical possibilities and expenditure limits, innovative mechanisms are needed to settle disputes if litigation and other costly transactions are to be minimized. Dr. Mechanic uses trust as a conceptual frame to understand better evolving structures, possible mediating institutions, and the social and ethical implications of varying models of doctor-patient relationships. He examines strategies for rationing health care resources, achieving integration between acute and chronic disease models, and enhancing the compatibility of efforts to improve physical and behavioral health. The project synthesizes work on trust relations in medicine, building on theory and empirical research from several disciplines. Dr. Mechanic uses interviews and analysis of provider survey data to help extend the picture of how new practice arrangements affect trust. He also looks at how the English National Health Service makes and seeks to legitimize rationing decisions. Results shed light on the forces influencing medical care and suggest alternative approaches to inevitable dilemmas.