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Public trust in health care: the system or the doctor?
  1. M W Calnan,
  2. E Sanford
  1. Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK
  1. Correspondence to:
 Professor M W Calnan
 Department of Social Medicine, Canynge Hall, Whiteladies Road, University of Bristol, Bristol BS8 2PR, UK;


Objectives: To examine how the public assess trust in health care in England and Wales.

Design: Postal structured questionnaire in cross sectional survey.

Setting: Random sample of people on the electoral register in England and Wales.

Subjects: People aged 18 and over.

Main outcome measures: General levels of trust and confidence in health care.

Results: The response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust.

Conclusion: Public assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise.

  • public trust
  • quality of care
  • doctor-patient relationship

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  • See editorial commentary, p 88

  • Funding: MRC HSRC.

  • Competing interests: none declared.

  • Michael Calnan initiated the study, developed the core ideas, designed the study, supervised the analysis and wrote the paper. Emma Sanford carried out the statistical analysis.

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