Building on a three-and-a-half-year partnership with the ABIM Foundation to advance research on trust, AcademyHealth is leading a new initiative with the Foundation focusing on the critical intersection of medical debt and trust in health care.
Medical debt has far-reaching consequences, not only for patients' financial well-being but also for their mental and physical health. The burden of medical debt can erode trust in health care systems and lead to poorer health outcomes. Patients burdened by debt may delay care, struggle to adhere to treatment plans, or face significant life disruptions such as difficulty affording basic necessities, increased credit card debt, or even bankruptcy.
Barriers to progress include insufficient policy protections, disconnects between system leaders and clinicians, and a lack of understanding about the full impact of medical debt policies on patients and their clinicians. Additionally, research gaps remain, such as understanding the effects of hospital debt collection policies on patient behavior and financial sustainability.
In response, this initiative seeks to:
- Explore the nature and prevalence of health system medical debt policies and practices and their impacts on patients and clinicians
- Fill critical research gaps related to medical debt and trust
- Promote cultural and operational transformation within health systems
By tackling medical debt and its associated harms, this initiative aims to contribute to a more equitable, patient-centered health care system that fosters trust between patients, clinicians, and their health systems to improve overall health outcomes.
External Publications
(September 2024) Health Care Workers' Trust in Leadership: Why It Matters and How Leaders Can Build It
In this article, Dr. Lauren Taylor (Trust Scholar in Residence) and her colleagues examine how health care workers’ trust in health system leadership impacts their professional satisfaction and quality of work. Opportunities for bolstering health care workers’ trust in their organizations are also explored through such means as transparent communications, treating health care workers with respect, providing good compensation, and prioritizing patient care.
(September 2024) Public Comfort with the Use of ChatGPT and Expectations for Healthcare
In this article, Jody Platt (Trust Scholar in Residence) and colleagues examine whether the public’s comfort with using ChatGPT differs from that of other uses of AI and whether this comfort, along with other aspects such as trust, privacy concerns, and tech-savviness, are associated with expected benefits in health improvement.
(June 2024) Addressing Medical Debt: Rebuilding Trust in Health Care
In June 2024, more than 60 health care leaders and advocates met to discuss best practices and promising approaches to address medical debt in the United States. This paper summarizes their insights, recommendations, and innovative strategies for alleviating the burden of medical debt, with a focus on advancing equity, improving financial protections for patients, and promoting systemic reforms in the health care landscape.
(June 2024) Best Practices For AI In Health Insurance Claims Adjudication And Decision-Making
In an article published in Health Affairs Forefront, Dr. Rachele Hendricks-Sturrup (Trust Scholar in Residence) and her colleagues discuss the ethical use of AI tools to process and adjudicate prior authorization requests for patients’ health insurance claims.
(April 2024) Improving Engagement in Community Level Data Collection
Dr. Rachele Hendricks-Sturrup (Trust Scholar in Residence) and her colleagues at the National Alliance against Disparities in Patient Health (NADPH) partnered with Data Equity Coalitions (DECs) and the CDC Foundation to publish a series of reports on Improving Engagement in Community Level Data Collection by improving the relevance, accessibility, and utility of public health data about the social determinants of health.
(May 2023) Understanding Clinician Trust in Health Care Organizations Should Be a Research Priority
The need to learn more about how to build trust to combat clinician burnout and improve health and health care could not be greater. In a blog post in JAMA Health Forum, Richard Baron, President and CEO of the ABIM Foundation, and Lisa Simpson, President and CEO of AcademyHealth, discuss how and why the field must learn and implement effective interventions to build trust between clinicians and the organizations where they work.
(March 2023) Fifty Years of Trust Research in Health Care: A Synthetic Review
This literature review, featured in The Milbank Quarterly, synthesizes five decades of research on trust in health care. Drs. Platt and Taylor (Trust Scholars in Residence) analyze the multifaceted role of trust across patient-provider relationships, health care organizations, and systems, emphasizing its critical influence on health outcomes and policy. The review provides a comprehensive framework for understanding trust dynamics and offers guidance for researchers and policymakers to address challenges in fostering equitable and effective healthcare systems.
(January 2023) Trust in Health Care: Insights from 50 Years of Research for Policymakers
In an article published in The Milbank Quarterly, Drs. Platt and Taylor (Trust Scholars in Residence) examine five decades of research on trust in health care, exploring how trust operates at multiple levels—from patients and providers to institutions and systems—and highlighting its impact on health outcomes, equity, and policy effectiveness. Key recommendations that policymakers can use to bolster trust in health care include:
- Creating and enforcing health policies that make exploitative behavior costly.
- Using their regulatory authority to address and mitigate harm from conflicts-of-interest and regulatory capture.
- Being transparent and effective about their role in the provision of health services to the public.
(January 2023) An Ecosystem Approach to Earning and Sustaining Trust in Health Care—Too Big to Care
In an essay published in JAMA Health Forum, An Ecosystem Approach to Earning and Sustaining Trust in Health Care—Too Big to Care, Dr. Platt (Trust Scholar in Residence) and her colleague explore the following questions:
- What is our current state of trust and trustworthiness? How are we connected to and affected by the context and complexity of the ecosystem in which we operate?
- How do our policies provide guardrails for trusted and trustworthy systems that prevent our systems from operating as too big to care?
- Are our trust-building initiatives meaningful, and not merely performative? Are our communications to educate or change minds coupled with learning and human connection?
- How are we managing the size of our enterprise? Are we too big to care? How are we leveraging size to implement trust-building approaches and disseminate knowledge?
(November 2022) The Overlooked Role Of Physician Trust In Patients
Trust Scholars in Residence Dr. Platt and Dr. Taylor, along with their colleagues, assert in their Health Affairs Forefront blog post that “the health care community is right to be concerned about emerging evidence that patients increasingly distrust the health care system at large, as well as the uptick in violence and other harms perpetrated against health care workers. It’s not hyperbolic to say that trust is what the whole health care delivery system runs on—and where it’s absent, we see major breakdowns. But the same is true about the trust that needs to flow from doctors to patients. Without it, the system will be similarly in jeopardy. Hence, our efforts to build patient trust should be matched by careful consideration of how to preserve physician trust in patients.
(May 2021) Surveys of Trust in the U.S. Health Care System
Conducted between December 29, 2020, and February 5, 2021 by NORC and the ABIM Foundation as part of the Foundation’s Building Trust Initiative, this survey explores consumers’ and physicians’ opinions and attitudes on trust in the U.S. health care system. With a special focus on the impact COVID-19 has had on the relationship between providers and their patients, this poll shows that patients trust clinicians more than other parts of the health care system. The survey also indicates a decline in physicians’ trust in leaders of health care systems during the COVID-19 pandemic.
(December 2020) Trust in Health Care in the Time of COVID-19
Although trust is a foundational component in building a strong patient-clinician relationship, trust in health care has been declining, particularly among communities who experience barriers to health care, health care disparities, and racism. COVID-19 has exacerbated these existing problems in many ways, from discordant recommendations, medical misinformation, and the disproportionate impact of the virus on Black and Latino communities. In this special series of Viewpoint articles published in JAMA, experts discuss ongoing threats to trust, particularly in the context of COVID-19 and ways to mitigate them. Introduced by Dr. David, Baker, these articles cover concerns related to medical misinformation, the importance of healing relationships for creating trust, how organizations can build and measure patient/community trust, the role that transparency plays in building trust.