TRUST IN MANAGED CARE ORGANIZATIONS

Two basic criticisms of managed care are that it erodes patients trust in physicians and subjects physicians to incentives and pressures that compromise the physicians fi duciary obligation to the patient. In this article, I fi rst distinguish between status trust and merit trust, and then argue (1) that the value of status trust in physicians is probably overrated and certainly underdocumented; (2) that erosion of status trust may not be detrimental if accompanied by an increase in well-founded merit trust; and (3) that under conditions of managed care the physicians commitment to traditional medical ethics cannot serve as an adequate basis for merit trust.