Friday, January 4, 2008

Trust (and lack thereof) in Health Organizations

Without trust, the patient-clinician relationship goes nowhere. Trust encourages us to adhere to the recommendations we receive. And, as the placebo effect shows, trust has powerful healing effects in itself.

But what about trust in the organizations that are increasingly central to healthcare?

An article in yesterday’s Wall Street Journal Health Blog about Morgan Stanley’s “Pharmaceutical CEOs Unplugged” conference reported on CEO claims that the industry is highly trusted. But a recent Harris poll suggests that Pharma is on its way to the dustbin of trust, just as happened to managed care.

When asked "which of these industries do you think are generally honest and trustworthy – so that you normally believe a statement by a company in that industry?" about a series of 17 industries, the winner by far was “none of the above.” 11% find pharmaceutical companies trustworthy. This is better than HMOs (5%), tied with airlines and car manufacturers, and worse than hospitals (28%) and banks (30%). Pharma is trending downward: 2003 (13%); 2004 (14%); 2005 (9%); 2006 (7%); 2007 (11%). When asked "which of these industries do you think should be more regulated by government – for example for health, safety or environmental reasons – than they are now?" Pharma (53%) tied with oil for first place.

With regard to regulation, in 2003 60% of those polled felt that HMOs should be more regulated. This percentage has dropped steadily, to 45% -- the largest change for any industry. But the decreased demand for regulation has come at a high cost to the public – in the form of premium increases as HMOs have backed off from managing care.

To promote quality and efficiency, societies have to manage care. But thus far we have not been able to do this without a fatal loss of trust. By managing less, the managed care industry has bought back some trust, but the cost increases driven by reduced management will not be sustainable for long.

The pressure on Pharma is not yet at the level that was brought to bear on HMOs, but the trend is in that direction. Pharma needs new strategies to rebuild trust. Public relations campaigns won't be enough.

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