Understanding the determinants of public trust in the health care system in China: an analysis of a cross-sectional survey

Objectives Despite increasing research attention on public trust in health care systems, empirical evidence on this topic in the developing world is limited and inconclusive. This paper examines the level and determinants of public trust in the health care system in China. Methods We used data from a survey conducted with a sample of 5347 adults in all Chinese provincial areas between January and February 2016. Trust in the health care system was assessed with a question used by the 2011-2013 International Social Survey Programme (ISSP) to assess public trust in the health care systems of 29 industrialized countries and regions ('In general, how much confidence do you have in the health care system in your country?'). Results Only 28% of respondents reported that they had a great deal or complete trust in China's health care system. Respondents who reported to have more trust in other people in society, more trust in the local government and who were more satisfied with their most recent health care system experience and their health insurance were significantly more likely to trust the country's health care system. Furthermore, respondents who reported a higher level of happiness, better health status and positive attitudes towards social equity were more likely to trust the health care system in China. Conclusions Our findings suggest that low public trust in China's health care system is a potential problem. Improving health care experiences may be the most practical and effective way of improving trust in the health care system in China.