Understanding Institutional Trust. What Does It Mean to Trust the Health System?

Abstract

Research on trust in the health system has been given more importance, since Hardin’s study (2006), which found a decrease in trust at the level of important democratic systems, (Canada, USA, UK, Sweden) and Fukuyama’s work (1995), where societies are divided into high-trust societies and low-trust societies. Yet the notion of trust is often regarded as ambiguous, difficult to define and to investigate. Trust has only recently begun to be measured and analyzed in the health sector and almost no empirical investigation has been conducted in developing countries. In high income countries this interest is associated with concern for the decline of trust in governments and professionals, and in developing countries has been prompted by debates around the notion of social capital. Empirical studies found a decrease in the degree of trust in medical institutions, which can be explained by epistemological challenges about the authenticity of knowledge (Popay et al. 2003), by a drop in trust in the power of science (Irwin and Michael, 2003), and by an increase in individual and social reflexivity (Giddens 1994, pp. 194–197). The purpose of this article is to identify—in scientific literature—the way in which trust in health systems and the determinants of a relationship based on trust have been measured. In the analysis, we used the PubMed database, without specifying a certain time interval, and the reports of the European Commission referring to health. The following concepts were used: trust, institutional trust, health system, literature review.