Public trust in health care : Exploring the mechanisms

The aim of this thesis is to investigate how public trust in health care is formed, by studying the mechanisms behind it, addressing the following research question: ‘Which mechanisms explain differences in public trust in health care?’. Public trust in health care is important. Low levels of trust in health care are related to counterproductive behaviors, such as delay in using health services or lower compliance with medical treatment. This means that low levels of public trust may lead to less effective treatment and higher health care costs. The mechanisms that we expected to have an impact on public trust in health care consist of two types: system-related and informational mechanisms. System-related mechanisms concern the health care system and the institutions surrounding the health care system, also called institutional guarantees. These guarantees relate to cultural beliefs, normative structures and regulatory systems that provide significance and stability to the health care sector. With regard to cultural beliefs, we expect that the belief that in general the health care system provides good quality care, will have an impact on public trust in health care within a country and that it can lead to differences between countries. The presence of normative and regulative guarantees is expected to lead to higher levels of public trust in health care. Informational mechanisms consist of personal experiences in health care, information from others and information received through various media including the radio, television, newspapers and the internet. Positive information is expected to lead to higher levels of trust, whereas negative information is expected to lead to lower levels. Additionally, we assume that negative information will have a greater impact on public trust in health care than positive information (negativity-effect). Objects of public trust in health care can be found on two levels. Public trust can be placed in groups of people and institutions on a macro-level (occupational groups in general, institutions in general, or the health care system) and on a meso-level (health care providers working in a specific institution or a specific institution itself). Therefore, the impact of the mechanisms on public trust has been studied on both levels. Next to that, we have studied both conventional health care and complementary and alternative medicine (CAM). This thesis was the first to present a theoretical model on the mechanisms influencing public trust in health care. Evidence was presented that suggested that both the mechanisms related to systems, as well as the informational mechanisms, have an impact upon public trust in health care. This thesis provides new insight into mechanisms influencing public trust in health care, but it still leaves some questions unanswered