Elsevier

Health Policy

Volume 81, Issue 1, April 2007, Pages 56-67
Health Policy

Public trust in health care: A comparison of Germany, The Netherlands, and England and Wales

https://doi.org/10.1016/j.healthpol.2006.04.004Get rights and content

Abstract

This article describes public trust in health care in three European countries. Public trust is a generalised attitude, influenced by people's experiences in contacts with representatives of institutions, in its turn influencing how people enter these contacts. In general, people in Germany have less trust in health care, while people in England and Wales have the highest trust levels. Cultural differences between the three countries could be an important source of differences. That makes public trust a less straightforward candidate for use as indicator of the future oriented dimension of user views in an international, comparative performance framework.

Introduction

Performance of health care has objective, outcome oriented dimensions as well as subjective dimensions of user evaluation. User evaluations might be conceptualised in three dimensions. The first consists of actual experiences in contact with health care [1], as measured e.g. by instruments such as CAHPS [2], [3]. The second is an evaluative dimension, as measured e.g. by the value users attach to aspects of health care [4]. Finally, a future expectations oriented dimension can be distinguished, measured by public trust in health care [5]. Actual experiences and evaluations are increasingly used in international comparisons [6], [7], [8], [9]. The first international comparison of public trust in health care is reported in this article. We compare three Western European countries: England and Wales, Germany and The Netherlands. In this article we briefly introduce the concept of public trust in health care and its relation to interpersonal trust. We relate the way public trust is built to differences between health care systems. Having only three health care systems in our study precludes systematic hypothesis testing. Therefore the emphasis in this study is on describing the differences between countries. However, in an explorative analysis an important issue is whether differences in public trust reflect differences in the health care systems studied. When it is found that actual differences of the health care systems are reflected, public trust could be used as an indicator of the future oriented dimension of user views in a performance framework. Alternatively, when differences in public trust foremost reflect cultural differences in placing trust, measures of public trust are less useful as an element of comparison of performance of health care systems.

Section snippets

Public trust, interpersonal trust and health care system differences

Trust is essential for the smooth functioning of society. As Fukuyama [10] stated “Trust is the grease that keeps the wheels of society moving”. Literature identifies two distinct forms of trust: interpersonal trust and public trust. Interpersonal trust is trust placed by one person in another. The future expectations aspect of trust is especially clear from Sztompka's [11] definition of trust as: “A bet about the future contingent actions of others”. Public trust is trust placed by a group or

Data sources and methods

We collected data on public trust in health care in three countries: The Netherlands, Germany and England and Wales, using a postal questionnaire.

Public trust in health care, the six dimensions

Trust-judgements of inhabitants of England and Wales, The Netherlands and Germany on the dimension ‘patient focus of providers’ differ significantly (F = 46.9, df = 4, p < 0.001) (Fig. 2 and Appendix A). The Dutch respondents are more trusting regarding this dimension, compared to the respondents from England and Wales and Germany. The Germans place significantly less confidence in the ‘patient focus of providers’.

Dimension 2 reports on confidence that macro-level policies do not have negative

Discussion and policy implications

Trust in public service areas is regularly measured in different countries [23], although health care tends to have been neglected. Public trust in health care, however, is an important concept, in that it is an indicator of the level of support of the health care sector [21], an important resource in policy-making and governance [24] and it taps the future oriented dimension of performance of health care systems. This article fills the gap in knowledge on public trust in health care by

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