Why trust in the health care system matters
Lower trust leads to less preventative care, new Johns Hopkins research shows
- Image Moyo Studio
Americans trust doctors and nurses, but not the health care system as a whole, and that disparity is affecting health outcomes, according to new research from professors at Johns Hopkins University’s Carey Business School.
The researchers polled 1,235 U.S. residents about their trust in different sectors of their health care system and their non-emergency health care behavior. Just 35.5% of respondents in the lowest quartile for trust received a flu shot, while 68.4% in the highest trust quartile got the shot. Similarly, 64.8% in the lowest trust quartile had a physical exam, compared to 78.7% in the highest trust quartile.
“Variation is just as important in exploring whether or not somebody gets a flu shot, whether or not somebody goes for a COVID-19 vaccine, whether or not they go in for primary care, as things we know are important, like education and income,” said Michael E. Darden, one of the researchers, during a recent event on building trust in health care held at the Johns Hopkins University Bloomberg Center.
More complex and costly
Darden pointed to the complexity of the medical system as a key reason for the distrust. Instead of regularly seeing the same general practitioner, Americans today see different physicians in the same group, which is likely owned by a larger hospital or private equity firm. New technology has put even more layers between patients and doctors.
“Paradoxically, despite the fact that medical science is so much better, we have a system that makes it difficult,” he said.
Richard Burr, a former senator from North Carolina, pointed to confusion over health care costs as a key driver of distrust. When he talked to colleagues and friends about their treatment, “they didn’t feel that they were getting the value,” he said. “It made me then question, how do you how do you gauge trust? What is the definition of trust? And I think to some, it’s access to health care. To some, it’s the cost, and to others, it’s the value.”
Potential solutions
When it comes to solutions to bolstering trust in the health care system, Burr said making prices transparent so patients could comparison shop would help.
Lauren Taylor, an assistant professor in the Department of Population Health at New York University, said she’s “less optimistic” that it would work.
“People aren’t as rational consumers as we want them to be,” she said. It’s difficult for physicians to provide estimates for the cost of care because they don’t know what’s needed before starting a procedure.
Taylor encouraged doctors and nurses, the most trusted elements of the health care system, to talk with patients about their roles to help more people feel better about it. She also suggested administrators and leaders acknowledge past breaches of trust, even if they feel like long-ago history.
“Before you can say, ‘You should trust me for this reason,’ you have to first acknowledge historical legacies that maybe no one alive experienced directly but are carried forward intergenerationally,” she said.