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Frontiers of Medicine

Front. Med.    2019, Vol. 13 Issue (4) : 504-510     https://doi.org/10.1007/s11684-018-0666-4
RESEARCH ARTICLE
Changes in public trust in physicians: empirical evidence from China
Dahai Zhao1, Zhiruo Zhang2()
1. School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, China
2. School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
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Abstract

Studies examining the trends in public trust in physicians have provided a considerable amount of valuable policy implications for policymakers compared with cross-sectional studies on this topic in many countries. This study investigated changes in public trust in physicians in China based on two cross-sectional national surveys conducted in 2011 and 2016 and identified the determinants of these changes. The results indicated 83.4% of respondents in 2011 reported trust or strong trust in physicians in China, which decreased to 64.2% by 2016. The results of ordinal logistic regression demonstrated that public trust in physicians in China had decreased significantly from 2011 to 2016 (P<0.001) after adjusting for other independent variables. Self-reported health status, self-rated happiness, and self-identified social class were all associated positively with public trust in physicians in China. The results also confirmed that decreasing public satisfaction with the most recent treatment experience was the major determinant of decreasing public trust in physicians in China. The findings of this study suggest that decreasing public trust in physicians deserves considerable attention from national policymakers and that improving satisfaction with treatment experiences would be the most effective strategy for enhancing public trust in physicians in China.

Keywords trust in physicians      public trust      physician-patient relationship      health system performance     
Corresponding Authors: Zhiruo Zhang   
Just Accepted Date: 09 August 2018   Online First Date: 07 September 2018    Issue Date: 02 August 2019
 Cite this article:   
Dahai Zhao,Zhiruo Zhang. Changes in public trust in physicians: empirical evidence from China[J]. Front. Med., 2019, 13(4): 504-510.
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http://journal.hep.com.cn/fmd/EN/10.1007/s11684-018-0666-4
http://journal.hep.com.cn/fmd/EN/Y2019/V13/I4/504
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Dahai Zhao
Zhiruo Zhang
Variable 2010 2011 (n = 4586) 2016 (n = 4260)
Value Value Weighted value Value Weighted value
Sex
Male 50.6 45.4 50.5 49.9 50.5
Female 49.4 54.6 49.5 50.1 49.5
Age (year) 47±16 43±16 37±14 42±15
18–29 25.9 15.8 25.7 35.3 25.7
30–39 20.6 17.7 20.4 27.4 20.4
40–49 22.0 22.4 21.9 16.0 21.9
50– 31.5 44.1 32.0 21.3 32.0
Education
Primary school and below 29.8 36.7 30.3 6.8 30.3
Junior high school 43.6 31.2 43.3 16.2 43.3
High school and professional school 15.4 17.7 15.3 22.8 15.3
College and above 11.2 14.4 11.1 54.1 11.1
Marital status
Others 24.9 20.7 22.4 28.7 18.8
Married 75.1 79.3 77.6 71.3 81.2
Urban or rural dwelling
Outside of urban areas 49.4 42.8 44.5 40.5 35.8
In urban areas 50.6 57.2 55.5 59.5 64.2
Health insurance coverage
No health insurance 5.0 12.9 14.3 8.1 8.4
Private health insurance 5.0 3.7 3.9 8.1 8.5
Public health insurance 90.0 83.4 81.8 83.9 83.0
GDP per capita in each province (10 thousand RMB) 4±1.9 4±1.7 6±2.8 6±2.7
Tab.1  Characteristics of the demographic variables from the surveys and the national census (%)
Variable 2011 (n= 4586) 2016 (n = 4260)
Trust in physicians 3.82±0.73 3.53±0.81
Strongly disagree 1.0 0.7
Disagree 7.9 14.0
Neither agree nor disagree 7.7 21.1
Agree 74.6 60.2
Strongly agree 8.8 4.0
Self-identified social class 4.14±1.77 4.60±2.24
Range 1–10 1–10
Self-reported health status
Poor 10.0 3.0
Fair 33.8 30.9
Good 21.5 8.6
Very good 25.6 29.3
Excellent 9.0 28.1
Self-rated happiness
Very unhappy 1.7 1.0
Quite unhappy 6.8 3.6
Neither unhappiness nor happiness 11.0 14.9
Quite happy 60.1 55.1
Very happy 20.3 25.5
Frequency of doctor visits
Never 19.6 38.2
Seldom 40.8 43.1
Sometimes 26.6 11.2
Often 11.4 7.1
Very often 1.7 0.4
Satisfaction with the last treatment
Completely dissatisfied 1.0 0.4
Very dissatisfied 2.5 2.7
Fairly dissatisfied 8.2 10.8
Neither satisfied nor dissatisfied 12.6 31.4
Fairly satisfied 63.1 44.0
Very satisfied 10.2 5.2
Completely satisfied 2.4 5.5
Tab.2  Comparison of variables between the surveys in 2011 and 2016 (%)
Coefficient Standard error P 95% confidence interval
Year (2016/2011) −0.880 0.064 <0.001 −1.006 to−0.754
Satisfaction with most recent treatment experience 0.571 0.023 <0.001 0.526 to 0.616
Self-rated happiness 0.174 0.029 <0.001 0.117 to 0.231
Frequency of doctor visits −0.014 0.026 0.599 −0.065 to 0.038
Self-reported health status 0.085 0.021 <0.001 0.044 to 0.126
Self-identified social class 0.050 0.012 <0.001 0.026 to 0.073
Sex −0.016 0.048 0.735 −0.110 to 0.077
Age 0.013 0.002 <0.001 0.010 to 0.016
Marital status −0.044 0.057 0.437 −0.155 to 0.067
Urban or rural dwelling −0.028 0.052 0.587 −0.131 to 0.074
GDP per capita in each province −0.036 0.010 0.001 −0.056 to−0.016
Elementary school and below 0.179 0.095 0.059 −0.007 to 0.364
Junior high school 0.028 0.081 0.728 −0.186 to 0.130
High school and professional school 0.218 0.089 0.015 −0.393 to−0.042
College and above Reference
No health insurance −0.088 0.073 0.230 −0.231 to 0.056
Private health insurance 0.183 0.096 0.056 −0.005 to 0.370
Public health insurance Reference
Tab.3  Ordinal logistic regression for public trust in China’s physicians (n = 8846)
1 D Mechanic. Public trust and initiatives for new healthcare partnerships. Milbank Q 1998; 76(2): 281–302
https://doi.org/10.1111/1468-0009.00089 pmid: 9614423
2 MA Hall, F Camacho, E Dugan, R Balkrishnan. Trust in the medical profession: conceptual and measurement issues. Health Serv Res 2002; 37(5): 1419–1439
https://doi.org/10.1111/1475-6773.01070 pmid: 12479504
3 E MÜller, JM Zill, J Dirmaier, M Härter, I Scholl. Assessment of trust in physician: a systematic review of measures. PLoS One 2014; 9(9): e106844
https://doi.org/10.1371/journal.pone.0106844 pmid: 25208074
4 MW Calnan, E Sanford. Public trust in healthcare: the system or the doctor? Qual Saf Healthcare 2004; 13(2): 92–97
https://doi.org/10.1136/qshc.2003.009001 pmid: 15069214
5 YY Lee, CT Ng, MG Siti Aishah, JZ Ngiam, BC Tai, MK Lim, K Hughes. Public trust in primary care doctors, the medical profession and the healthcare system among Redhill residents in Singapore. Ann Acad Med Singapore 2007; 36(8): 655–661
pmid: 17767336
6 MA Hall, E Dugan, B Zheng, AK Mishra. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 2001; 79(4): 613–639
https://doi.org/10.1111/1468-0009.00223 pmid: 11789119
7 E van der Schee, B Braun, M Calnan, M Schnee, PP Groenewegen. Public trust in healthcare: a comparison of Germany, The Netherlands, and England and Wales. Health Policy 2007; 81(1): 56–67
https://doi.org/10.1016/j.healthpol.2006.04.004 pmid: 16777257
8 RJ Blendon, JM Benson, JO Hero. Public trust in physicians—U.S. medicine in international perspective. N Engl J Med 2014; 371(17): 1570–1572
https://doi.org/10.1056/NEJMp1407373 pmid: 25337746
9 E van der Schee, PP Groenewegen, RD Friele. Public trust in healthcare: a performance indicator? J Health Organ Manag 2006; 20(5): 468–476
https://doi.org/10.1108/14777260610701821 pmid: 17087406
10 F Gille, S Smith, N Mays. Why public trust in healthcare systems matters and deserves greater research attention. J Health Serv Res Policy 2015; 20(1): 62–64
https://doi.org/10.1177/1355819614543161 pmid: 25038059
11 D Peters, FF Youssef. Public trust in the healthcare system in a developing country. Int J Health Plann Manage 2016; 31(2): 227–241
https://doi.org/10.1002/hpm.2280 pmid: 25533779
12 W Yip, W Hsiao. What drove the cycles of Chinese health system reforms? Health Sys Reform 2015; 1(1): 52–61
https://doi.org/10.4161/23288604.2014.995005
13 D Blumenthal, W Hsiao. Privatization and its discontents—the evolving Chinese healthcare system. N Engl J Med 2005; 353(11): 1165–1170
https://doi.org/10.1056/NEJMhpr051133 pmid: 16162889
14 D Blumenthal, W Hsiao. Lessons from the East—China’s rapidly evolving healthcare system. N Engl J Med 2015; 372(14): 1281–1285
https://doi.org/10.1056/NEJMp1410425 pmid: 25830419
15 ISSP Research Group. International Social Survey Programme: Health and healthcare—ISSP 2011 GESIS Data Archive. ZA5800 Data file Version 3.0.0 ed. Cologne 2015
16 AC Kao, DC Green, NA Davis, JP Koplan, PD Cleary. Patients’ trust in their physicians: effects of choice, continuity and patient perceptions of physician payment method. J Gen Intern Med 1998; 13(10): 681–686
https://doi.org/10.1046/j.1525-1497.1998.00204.x pmid: 9798815
17 LE Boulware, LA Cooper, LE Ratner, TA LaVeist, NR Powe. Race and trust in the healthcare system. Public Health Rep 2003; 118(4): 358–365
https://doi.org/10.1016/S0033-3549(04)50262-5 pmid: 12815085
18 K Haven, MF Celaya, J Pierson, AJ Weisskopf, NJ Mackinnon. Comparison of health confidence in rural, suburban and urban areas in the UK and the USA: a secondary analysis. BMJ Open 2013; 3(5): e002640
https://doi.org/10.1136/bmjopen-2013-002640 pmid: 23645916
19 K Armstrong, A Rose, N Peters, JA Long, S McMurphy, JA Shea. Distrust of the healthcare system and self-reported health in the United States. J Gen Intern Med 2006; 21(4): 292–297
https://doi.org/10.1111/j.1525-1497.2006.00396.x pmid: 16686803
20 National Bureau of Statistics of China. Tabulation on the 2010 population census of the People’s Republic of China. Beijing: China Statistics Press, 2012
21 DR Johnnson. Using weights in the analysis of survey data. (Accessed May 5, 2018)
22 SM Gainsbury, A Russell, N Hing, R Wood, D Lubman, A Blaszczynski. How the Internet is changing gambling: findings from an Australian Prevalence Survey. J Gambl Stud 2015; 31(1): 1–15
https://doi.org/10.1007/s10899-013-9404-7 pmid: 23934369
23 D Zhao, Z Zhang. Qualitative analysis of direction of public hospital reforms in China. Front Med 2018; 12(2):218–223
https://doi.org/10.1007/s11684-017-0534-7 pmid: 28674836
24 D Zhao, W Hu. Determinants of public trust in government: empirical evidence from urban China. Int Rev Adm Sci 2017; 83(2): 358–377
https://doi.org/10.1177/0020852315582136
25 D Zhao, K Rao, Z Zhang. Patient trust in physicians: empirical evidence from Shanghai, China. Chin Med J (Engl) 2016; 129(7): 814–818
https://doi.org/10.4103/0366-6999.178971 pmid: 26996477
26 SM Kehoe, JR Ponting. Value importance and value congruence as determinants of trust in health policy actors. Soc Sci Med 2003; 57(6): 1065–1075
https://doi.org/10.1016/S0277-9536(02)00485-9 pmid: 12878106
27 SD Goold, D Fessler, CA Moyer. A measure of trust in insurers. Health Serv Res 2006; 41(1): 58–78
https://doi.org/10.1111/j.1475-6773.2005.00456.x pmid: 16430601
28 PD Cleary. Evolving concepts of patient-centered care and the assessment of patient care experiences: optimism and opposition. J Health Polit Policy Law 2016; 41(4): 675–696
https://doi.org/10.1215/03616878-3620881 pmid: 27127265
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