Influence of Age on Patient Expectations of Physicians and Health Plans

The US Census Bureau projects that adults who are 65 years and older are one of the fastest growing segments of the US population. By 2050, the proportion of older persons is predicted to reach nearly 20% of the US population. Older and middle-aged persons are generally more likely to have greater health care needs than their younger counterparts. Age differences in health care needs and subsequently, the frequency of interactions with the health care system may be due to the demands of managing chronic illnesses or seeking preventive services to reduce age-related risk for health problems (e.g.- screening for diabetes, cancer).

The purpose of this study was to assess age-related differences in patient evaluations of how well physicians and health plans meet the role expectations for patient trust and medical professionalism.

Data are from a nationally representative telephone survey (n=5000) of primarily privately-insured adults. Data were analyzed using multivariate logistic regression models with adjustment for the complex sampling design. The various role expectations included patient advocacy, caring, racial fairness, honesty and technical competence of physicians and health plans.

After adjusting for race, health status, perceived vulnerability, region, and other variables, younger respondents (under 45 years) were nearly twice as likely as middle-aged respondents to indicate low trust in the technical competence of physicians particularly regarding medical error rates (OR=1.85). For another dimension of trustworthiness, patient agency, age had a negative effect where the elderly were less likely to believe physicians acted as poor patient advocates compared to the middle-aged (OR=0.50). Respondents with a poor-rated health status were more than twice as likely as their healthier counterparts to expect incompetence (many medical errors) among physicians. The only trust expectation regarding health plans that had a significant age effect was racial fairness. The older respondents were more likely than the middle aged comparison group to expect racial differences in how health plans to treat their enrollees (OR=1.89). Respondents who reported having a chronic illness had low trust in health plans on two dimensions: professionalism/caring (OR=1.42) and the ability to provide adequate health care access (OR=1.34).

Exploring the nature of age-related differences in expectations is especially important as these differences may affect 1) patients' clinical decision making, 2) patient perceptions of negative health care encounters and their responses to them, and ) patient adherence. These results have significant clinical implications for older persons with chronic illnesses and perhaps minority elders.