Is the U.S. Healthcare System Trustworthy?

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

The answer may not be yes in some circles, and in every sector of healthcare, it’s a growing concern.

Monday, the Navigant Center for Healthcare Research and Policy Analysis team participated in a meeting of the Consortium of Trustworthy Organizations(1) in New York City, where drug manufacturers pondered the question. Then Friday, in California, at convocation of five large medical groups, the trustworthiness of the medical profession was again prominent.

Polling data about the U.S. healthcare system show its trustworthiness is in jeopardy. Consider:

• Only 37% of the US adult population has confidence in the U.S. medical system.(2)
• From 1999 to 2006, America’s least trusted institutions were health maintenance organizations (ranging from 15-18%), replaced by Congress as least trusted in 2007 which is trusted by only 8%.(2)
• Only 8% of consumers trust their health insurers as a source for health and wellness and just 10 % trust their employers.(3)
• Only 34% of US adult consumers believe that multinational drug companies have an excellent or good reputation–a 19% decline from the prior year—citing failure to assist patients in securing medications in a difficult economic environment; offering drugs with only short-term health benefits; not serving the needs of neglected patient groups; inappropriate marketing of drugs; a lack of fair pricing policies; making drugs unaffordable to many patients; a lack of transparency in corporate activities; adverse news about products; and not acting with integrity.(4)
• Healthcare providers are trusted – nurses (80%), physicians (65%), pharmacists (65%) and dentists (62% – remain America’s most respected professionals based on their perceived honesty and ethical standards (though all have slipped slightly) contrasted to HMO managers (12%), car salespersons (8%), Members of Congress (7%) and lobbyists (6%).(5)
• And Americans of all generations are losing trust; distrust Is more closely correlated with income inequality than age. Currently, 22% of the public is optimistic about its future of the U.S. health system but 53% are pessimistic.(6)

Healthcare’s not alone: the public’s view of its major institutions reflect erosion of trustworthiness. Opinions about government, big business, Congress, police, the media and organized religion are at all-time lows.5 Trust in our institutions including the healthcare system is an issue we must confront.

Much has been written about institutional trust: Fordham Professor Rob Hurley, Director, of the Consortium for Trustworthy Organizations, characterizes trustworthy organizations along six dimensions.(6) His was the framework used in New York last Monday (See Special Report: Consortium for Trustworthy Organizations in Industry Pulse). In academic circles, it’s closely associated with the integrity and ethicality of an organization’s leaders, avoidance of scandal, consistency of performance, and support for the organization’s mission beyond its own profits. Trust in organizations is built over many years and correlates with business success: as much as 40-60% of a company’s intangible asset value is attributable to its brand.(7) It’s also fragile—one performance mishap mishandled, one leader whose behavior is contemptible, one credible challenge to the organization’s image by a current or former customer or employee and the trust is impaired.

In healthcare, transparency is the new normal: virtually all business relationships are subject to disclosure the social media buzz about healthcare is frenetic. As health costs increase, consolidation within sectors and across sectors will prompt regulator attentiveness and increased public scrutiny. As a result, the trustworthiness of the system will be tested. Therefore, each sector must address its vulnerabilities to real or perceived gaps in trustworthiness and aggressively address those in its ranks who threaten the reservoir of trust built by the majority over decades.

In hospitals, forthrightness about safety and error, purposeful attention to care that’s rendered unnecessarily, transparency about costs, and the use of operating profits (surpluses) are high priorities.

In medical practices, disclosures of business conflicts of interest, disciplining peers who deliver suboptimal care or, embracing information technologies proven to improve diagnostic accuracy and care coordination, and embracing consumers as shared decision-makers are trust-building priorities.

In drug and device manufacturing, marketing practices that cross the line of ethicality, pricing gauging, disclosure of scientific evidence about the efficacy and effectiveness of innovations including those that fail, business relationships with investigators that participate in its R&D, and purposeful corporate benevolence are trust imperatives.

In health insurance companies, transparency in business practices around coverage and denials, provider performance ratings, and premium setting, ethicality in plan discontinuation, disclosures of conflicts of interest in related businesses, and executive compensation that’s significantly linked to factors other than financial performance are important foci for trust.

Being a trustworthy organization in healthcare is good business.  More important, building, restoring and maintaining trust in the U.S. health system is necessary to its future. It’s not what it could be.

Paul

Sources:

1 – Consortium of Trustworthy Organizations: Trust and Patient Value in Health Care November 9, 2015 Fordham University; Samantha Smith, “From the very Start, Sharp Partisan Divisions over ObamaCare,” Pew Research Center, June 25, 2015

2 – “Public Trust in Government: 1958-2013,” Pew Research Center, October 18, 2013; “Young Adults Less Trusting In General but with Exceptions,” Pew Research Center, May 23, 2013; “Confidence in U.S. Institutions Still Below Historical Norms,” Gallup, June 15, 2015; Twenge, Jean M., Campbell, W. Keith, Carter, Nathan T., “Declines in Trust in Others and Confidence in Institutions Among American Adults and Late Adolescents, 1972-2012,” Psychological Science, 2014, Vol. 25(10), 1914-1923. doi: 10.1177/0956797614545133; Eelman Trust Barometer: Life Sciences and Trust, 2013

3 – “Welltok Survey Finds Consumers Struggle to Achieve Optimal Health on Their Own”

4 – “ Restoring the pharmaceutical industry’s reputation,” Nature October 29, 2014;Baum, S., “Survey finds lack of transparency drags down pharma reputation among patient groups,”Medcity News (15 January 2013)

5 – Honesty/Ethics in Professions, Gallup

6 – Physician Foundation Consumer Omnibus Survey, Physicians Foundation

7 – Brigham, A.F. & Linssen, S., “Your brand reputational value is irreplaceable. Protect it!” Forbes, February 1, 2010; Gaines-Ross, L., Corporate Reputation, 12 Steps to Safeguarding and Recovering Reputation, John Wiley & Sons, Hoboken, NJ, 2008

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.