The Health Care Outcomes of Trust: A Review of Empirical Evidence
This chapter explores how health care access, quality, and related health care outcomes are linked to interpersonal and generalized trust. The types of trust we focus on include trust between patients and physicians, trust or confi dence in the medical system and institutions, and trust inherent in patients’ networks outside of health care environments. The relationships between these types of trust and health care outcomes are not well understood. Previous research on the antecedents of health care access, utilization, and quality has focused primarily on sociodemographic, neighborhood and geographical characteristics, health insurance, health status, and the type of health care facilities. Andersen (1995) classifi es factors that contribute to health care outcomes as (a) enabling factors (e.g., income, type of health care insurance, etc.), (b) need-based factors (e.g., health status, perceived symptoms, etc.), and (c) predisposing factors (e.g., preferences for health care use and other non health-related factors affecting demand for care). Trust, though not explicitly included in Andersen’s typology, could be considered a predisposing factor. The decision to seek health care is partially determined by the level of an individual’s trust in providers and in medical institutions more broadly. Essentially, a patient who goes to the trouble of visiting a doctor must believe, to some degree, that the health care services she receives will reduce her symptoms, help her heal, and eventually lead to a better quality of life. Several empirical studies provide evidence consistent with the argument that a link exists between trust and health care outcomes. Our goal is to conduct a review of the existing empirical evidence to provide a more comprehensive picture of how various forms of trust relate to health care outcomes and to propose an empirical model of health care outcomes of trust. This model can serve as a base for further empirical research and theoretical development on the topic of trust and health care, as well as a useful tool in the applied realm of policies and interventions intended to improve health care outcomes.