Is the prevalence of gatekeeping in a community associated with individual trust in medical care?
GROUND: Consumer concerns about the restrictions of managed care may lead to distrust. OBJECTIVES: To examine whether a community’s level of gatekeeping activity is associated with an individual’s trust in medical care. RESEARCH DESIGN: Cross-sectional cohort (N = 49,929). SUBJECTS: Participants in a nationally representative sample derived from the Community Tracking Survey who had health insurance, had a usual source of care, made at least 1 physician visit, and resided in one of the sampled metropolitan areas with corresponding community-level data, including the prevalence of gatekeeping activity. MEASURES: Four questions measuring trust in physician. RESULTS: Individuals from communities with a higher prevalence of gatekeeping activity report less trust than individuals from areas with a lower prevalence of gatekeeping activity, after adjusting for whether that individual had a health plan with a gatekeeper requirement. For example, in communities with the highest prevalence of ga
