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April 7, 1999

Method of Physician Payment and Patient Trust

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(13):1173. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-13-jbk0407

To the Editor: The study by Dr Kao and colleagues1 offers interesting new information about patient perceptions of the health care system. However, there was no indication of the validity of the trust scale for evaluating the effects of financial incentives. Given the nonexperimental design of the study, it would be important to know whether the dimensionality and reliability and variances of the dependent variable are the same under the different types of payment. Four of the trust scale questions (including the overall trust measure) tested physician loyalty in an explicit conflict of interest implying a threat of undertreatment, while potential overtreatment was implied in only 1 question. It would seem important to explicitly measure both these potential conflicts of interest since physicians may increase their income under both fee-for-service and capitation payment in ways that do not benefit patients.

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