This article builds upon a multilevel theory of trust to explore the relationship between general trust in health care systems and general trust in physicians and the social-contextual factors that shape this relationship. We develop a model of trust in physicians emphasizing the embeddedness of individuals in broader social-institutional contexts. We analyze data from 30 countries in the 2011 International Social Survey Program (N = 38,068) and specify hierarchical linear models with macro-micro level interactions. At the individual level, we find that individuals who trust the health care system are more likely to trust physicians in general. At the country level, we find that respondents from countries with predominately publicly financed health care systems are more likely to trust physicians than their counterparts in countries with less public funding of the health care system. Finally, we find that the greatest predicted probability of trust in physicians is found among individuals who trust their publicly funded health care system and the lowest probability is among individuals who have no confidence in their privately funded health care system. Based on these findings, we call for greater attention to the interaction of micro- and macro-level factors in models of trust in physicians cross-nationally.
AbelWMEfirdJT (2013) The association between trust in health care providers and medication adherence among Black women with hypertension. Frontiers in Public Health1: 66.
2.
AhernMMHendryxMS (2003) Social capital and trust in providers. Social Science & Medicine57(7): 1195–1203.
3.
BauerDJCurranPJ. (2005) Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behavioral Research40(3): 373–400.
4.
BirkhäuerJGaabJKossowskyJ, et al. (2017) Trust in the health care professional and health outcome: A meta-analysis. PLoS ONE12(2): e0170988.
5.
BlendonRJBensonJMHeroJO (2014) Public trust in physicians—US medicine in international perspective. New England Journal of Medicine371(17): 1570–1572.
6.
CalnanMWRoweR (2008) Trust Matters in Health Care. UK: McGraw-Hill Education.
7.
CalnanMWSanfordE (2004) Public trust in health care: The system or the doctor?BMJ Quality & Safety13(2): 92–97.
8.
CampbellJRamsayJGreenJ (2001) Age, gender, socioeconomic, and ethnic differences in patients’ assessments of primary health care. BMJ Quality & Safety10(2): 90–95.
9.
Campos-CastilloCWoodsonBWTheiss-MorseE, et al. (2016) Examining the relationship between interpersonal and institutional trust in political and health care contexts. In: ShockleyENealTMSBornsteinBH, et al. (eds) Interdisciplinary Perspectives on Trust. New York: Springer, pp. 99–115.
10.
CoburnD (2006) Medical dominance then and now: Critical reflections. Health Sociology Review15(5): 432–443.
11.
CvetkovichGLöfstedtRE (2013) Social Trust and the Management of Risk. London: Routledge.
12.
Fregidou-MalamaMHyderAS (2021) Multilevel trust in international marketing of healthcare services: A five-country comparative study. International Business Review30(6): 101895.
13.
FulmerA (2018) Multilevel Trust Antecedents and Outcomes of Trust at Different Levels. In: SearleRHNienaberA-MISitkinSB (eds) The Routledge Companion to Trust. London: Routledge, pp. 143–160.
14.
FüzérKHuszárÁBodorÁ, et al. (2020) Social capitals, social class, and prosperity in high-trust and low-trust societies. International Journal of Sociology50(1): 48–67.
15.
GilleFSmithSMaysN (2017) Towards a broader conceptualisation of “public trust” in the health care system. Social Theory & Health15(1): 25–43.
16.
GilsonL (2003) Trust and the development of health care as a social institution. Social Science & Medicine56(7): 1453–1468.
17.
GrahamJLShahaniLGrimesRM, et al. (2015) The influence of trust in physicians and trust in the healthcare system on linkage, retention, and adherence to HIV care. AIDS Patient Care and STDs29(12): 661–667.
18.
HallMACamachoFDuganE, et al. (2002) Trust in the medical profession: Conceptual and measurement issues. Health Services Research37(5): 1419–1439.
19.
HerianMNNealTM (2016) Trust as a multilevel phenomenon across contexts: Implications for improved interdisciplinarity in trust research. In: ShockleyENealTMSBornsteinBH, et al. (eds) Interdisciplinary Perspectives on Trust. New York: Springer, pp. 117–130.
20.
HuangE. C-H.PuC.ChouY-J.HuangN. (2018). Public Trust in Physicians—Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries. Inquiry: The Journal of Health Care Organization, Provision, and Financing55:1–11. https://doi.org/10.1177/0046958018759174
21.
ISSP Research Group (2015) International Social Survey Programme: Health and Health Care—ISSP 2011 (ZA5800 Data file Version 3.0.0). Cologne: GESIS Data Archive.
22.
KimTJVonneilichNLüdeckeD, et al. (2017) Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries. Social Science & Medicine176: 158–165.
23.
KołczyńskaM (2020) Democratic values, education, and political trust. International Journal of Comparative Sociology61: 3–26.
24.
LaneC (1998) Introduction: Theories in the study of trust. In: LaneCBachmannR (eds) Trust Within and Between Organizations: Conceptual Issues and Empirical Applications. New York: Oxford University Press, pp. 1–30.
25.
LeeY-YLinJL (2009) The effects of trust in physician on self-efficacy, adherence and diabetes outcomes. Social Science & Medicine68(6): 1060–1068.
26.
LuhmannN (1979) Trust and Power: Two Works. Chichester: Wiley.
27.
MaarseH (2006) The privatization of health care in Europe: An eight-country analysis. Journal of Health Politics, Policy and Law31(5): 981–1014.
28.
MaarseHJeurissenP (2019) Low institutional trust in health insurers in Dutch health care. Health Policy123(3): 288–292.
29.
MarmorTWendtC (2012) Conceptual frameworks for comparing healthcare politics and policy. Health Policy107(1): 11–20.
30.
MechanicD (1996) Changing medical organization and the erosion of trust. The Milbank Quarterly74: 171–189.
31.
MechanicD (1998) The functions and limitations of trust in the provision of medical care. Journal of Health Politics, Policy and Law23(4): 661–686.
32.
MechanicDMeyerS (2000) Concepts of trust among patients with serious illness. Social Science & Medicine51(5): 657–668.
33.
MeyerSWardPCoveneyJ, et al. (2008) Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann. Health Sociology Review17(2): 177–186.
34.
MohseniMLindstromM (2007) Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study. Social Science & Medicine64(7): 1373–1383.
35.
NguyenGCLaVeistTAHarrisML, et al. (2009) Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflammatory Bowel Diseases15(8): 1233–1239.
36.
NiedlichSKallfassAPohleS, et al. (2021) A comprehensive view of trust in education: Conclusions from a systematic literature review. Review of Education9(1): 124–158.
37.
PolilloS (2012) Globalization: Civilizing or destructive? An empirical test of the international determinants of generalized trust. International Journal of Comparative Sociology53(1): 45–65.
38.
PreacherKJCurranPJBauerDJ (2006) Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of educational and behavioral statistics 31(4): 437–448.
39.
RaudenbushSWBrykAS (2002) Hierarchical Linear Models: Applications and Data Analysis Methods. Thousand Oaks, CA: SAGE.
40.
RelmanAS (1994) The impact of market forces on the physician-patient relationship. Journal of the Royal Society of Medicine87(Suppl. 22): 22–24.
41.
SaarinenAORäsänenPKouvoA (2016) Two dimensions of trust in physicians in OECD-countries. International Journal of Health Care Quality Assurance29: 48–61.
42.
SafranDGTairaDARogersWH, et al. (1998) Linking primary care performance to outcomes of care. Journal of Family Practice47: 213–220.
43.
ShapiroSP (1987) The social control of impersonal trust. American Journal of Sociology93(3): 623–658.
44.
ShoreDA (2007) The Trust Crisis in Healthcare: Causes, Consequences, and Cures. Oxford; New York: Oxford University Press.
45.
SmileyKTYangY (2021) Do urban Europeans trust their fellow city dwellers? Immigration, group threat, and intergroup contact in 63 European cities. International Journal of Sociology51: 23–47.
46.
SungPSonJ (2020) In-group trust and self-rated health in East Asia using quadri-national survey data. International Journal of Comparative Sociology61(1): 27–58.
47.
The World Bank Database (2011) World Development Indicators. Washington, DC: The World Bank. Available at: http://data.worldbank.org/ (accessed 11 November 2020).
48.
TrachtenbergFDuganEHallMA (2005) How patients’ trust relates to their involvement in medical care. Journal of Family Practice54(4): 344–354.
49.
TuohyCHFloodCMStabileM (2004) How does private finance affect public health care systems? Marshaling the evidence from OECD nations. Journal of Health Politics, Policy and Law29(3): 359–396.
50.
Van Der ScheeEBraunBCalnanM, et al. (2007) Public trust in health care: A comparison of Germany, The Netherlands, and England and Wales. Health Policy81(1): 56–67.
51.
WardPR (2006) Trust, reflexivity and dependence: A “social systems theory” analysis in/of medicine. The European Journal of Social Quality6(2): 143–158.
52.
WardPR (2017) Improving access to, use of, and outcomes from public health programs: The importance of building and maintaining trust with patients/clients. Frontiers in Public Health5: 22.
53.
WardPRRokkasPCenkoC, et al. (2015) A qualitative study of patient (dis)trust in public and private hospitals: The importance of choice and pragmatic acceptance for trust considerations in South Australia. BMC Health Services Research15(1): 297.
54.
WardPRRokkasPCenkoC, et al. (2017) “Waiting for” and “waiting in” public and private hospitals: A qualitative study of patient trust in South Australia. BMC Health Services Research17: 333.
55.
WendtCKohlJ (2010) Translating monetary inputs into health care provision: A comparative analysis of the impact of different modes of public policy. Journal of Comparative Policy Analysis12(1–2): 11–31.
56.
WendtCFrisinaLRothgangH (2009) Healthcare system types: A conceptual framework for comparison. Social Policy & Administration43(1): 70–90.
57.
YoungY (2014) Social context and social capital: Governance, inequality, and the individual experience. International Journal of Sociology44(2): 37–62.
58.
YuanY (2021) Public satisfaction with health care system in 30 countries: The effects of individual characteristics and social contexts. Health Policy125(10): 1359–1366.
59.
ZuckerLG (1986) Production of trust: Institutional sources of economic structure, 1840–1920. Research in Organizational Behavior8: 53–111.
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