Public trust in health care: A comparison of Germany, The Netherlands, and England and Wales
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
References (37)
German translation and psychometric testing of the SF-36 health survey: preliminary results from the IQOLA Project
Social Science and Medicine
(1995)- et al.
Public trust in Dutch health care
Social Science and Medicine
(2002) - et al.
Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.
Bulletin of the World Health Organization
(2004) - et al.
Psychometric properties of the Dutch version of the Hospital-level Consumer Assessment of Health Plans Survey instrument
Health Services Research
(2006) - et al.
Quality of care from the patients’ perspective: from theoretical concept to a new measuring instrument
Health Expectations
(1998) - et al.
Measuring patients’ trust in physicians when assessing quality of care
Health Affairs
(2004) - et al.
Satisfaction with health systems in ten nations
Health Affairs
(1990) - et al.
Patients’ experiences with hospital care in five countries
Health Affairs
(2001) - et al.
The European patient of the future
(2003)
What is important in evaluating health care quality? An international comparison of user views
BMC Health Services Research
Trust: social virtues and the creation of prosperity
Trust a sociological theory
Changing medical organization and the erosion of trust
Milbank Quarterly
Why do we trust our congressman?
Journal of Politics
The impact of managed care on patients’ trust in medical care and their physicians
JAMA
The functions and limitations of trust in the provision of medical care
Journal of Health Politics Policy and Law
The relationship between method of physician payment and patient trust
JAMA
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2022, Social Science and MedicineCitation Excerpt :Interpersonal trust between patients and providers for example has been linked to better health outcomes; and interpersonal trust between healthcare workers and supervisors (‘workplace trust’) has been linked to healthcare workers' improved motivation and responsiveness towards service-users (Gilson et al., 2005; Sripad et al., 2018; Mechanic, 2004). Building on earlier work by van der Schee and colleagues (van der Schee et al., 2007) Gille and colleagues have more recently started to explore and deepen our conceptual understanding of what is meant by public trust in health systems; that is, a concept of trust which is not bound by the interpersonal relationships (patient-provider or employee-supervisor) and which may be applied at the level of group or society, rather than the individual (Gille et al., 2021). While recognising and supporting these advances to a broader conceptualization of public trust, there still remains work to be done with regards to understanding how individual trust in the healthcare system (or parts thereof) is produced.
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