Социальное доверие и недоверие в сфере российского здравоохранения в период пандемии COVID-19: теоретико-методологические подходы и источники негативизации

Abstract

Introduction. The article discusses theoretical approaches and methodological limitations of sociological research of trust and distrust to the healthcare services in the framework of the COVID-19 pandemic. The main difficulties are caused by the stable cognitive fashion for the quantitative measurement of trust/distrust indices. It leads to the illusion of understanding public opinion and social moods to this issue. The cognitive framework is also associated with the fundamental evaluative opposition of society's trust to medical care as a blessing and distrust as a socio-cultural barrier to the development of the healthcare system. Methods. The study is based on the methodology of sociological constructivism. Such approach makes it possible to study both mental and institutional factors that shape the crisis of public confidence to the health care services. Results and its discussion. The authors argue that social trust is constructed as a result of activity and requires directed efforts, an active position of key agents. Taking into account the neoliberal transformation of the healthcare institution in modern Russia, behavioral indicators of trust should be supplemented with information about objective indicators of the accessibility and quality of medical care. Based on empirical data, the dynamics of public opinion on the effectiveness of the Russian healthcare system and its main problems in a complex epidemiological situation are analyzed. The leading sources of negative social attitudes to the healthcare system during the COVID-19 pandemic are the following: aggressive policy of media; political decisions which are not always consistent and justified; claims for social control, external intervention in private space and strategies of medical activity in the society. The authors came to the conclusion that the COVID-19 pandemic only changed the structure of social attitude to the health care services, escalated chronic difficulties, but did not affect significantly the downward vector of consumer confidence in the health care system. The conclusion is made about the need for both systemic regulation of institutional mechanisms of trust, and increasing the reserve of personal responsibility and adaptive potential of consumers of medical care. In this regard, the relevance of sociological research in public health and healthcare will only increase in the post-coronavirus period. The synthesis of quantitative, qualitative assessments of trust and objective indicators of the availability and quality of medical care will make it possible to explain the dynamics of ideas, values and attitudes that shape the background of the social mood; to predict alternative scenarios and vectors for the transformation of the healthcare institution, depending on the semantic content of social trust / distrust to medical organizations.