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

  • Mihaela Rădoi
  • Adrian Lupu
Part of the Studies in Systems, Decision and Control book series (SSDC, volume 66)


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.


Trust Institutional trust Health system 



This paper was funded by the project “Program of excellence in multidisciplinary doctoral and postdoctoral research regarding chronic diseases”, Grant No. POSDRU/159/1.5/S/133377, beneficiary “Gr. T. Popa” University of Medicine and Pharmacy Iasi, a project co-funded by Social European Fund, through the Sectoral Operational Program Human Resources Development 2007–2013.


  1. Anderson, L., Dedrick, R.F.: Development of the trust in physician scale: a measure to assess interpersonal trust in patient physician relationships. Psyhological Rep. 67, 1091–1100 (1999)Google Scholar
  2. Armstrong, D.: Public health spaces and the fabrication of identity. Sociology 27, 393–410 (1993)CrossRefGoogle Scholar
  3. Baker, R., Mainous, A.G., Gray, D.P., Love, M.M.: Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scand. J. Prim. Health Care 21, 27–32 (2003)CrossRefGoogle Scholar
  4. Bartholomew, K., Horowitz, L.M.: Attachment styles among young adults: a test of a four-category model. J. Pers. Soc. Psychol. 61(2), 226–244 (1991)CrossRefGoogle Scholar
  5. Bauman, Z.: Legislators and Interpreters: On Modernity. Cambridge University Press, Postmodernity and Intellectuals, Cambridge (1987)Google Scholar
  6. Buchanan, A.: Trust in managed care organizations. Kennedy Inst. Ethics J. 10(3), 189–212 (2000)CrossRefGoogle Scholar
  7. Calnan, M.W., Sanford, E.: Public trust in health care: the system or the doctor? Qual. Saf. Health Care 13, 92–97 (2004)Google Scholar
  8. Calnan, M., Rowe, R.: Researching trust relations in health care: conceptual and methodological challenges—introduction. J. Health Organ. Manage. 20(5), 349–358 (2006)CrossRefGoogle Scholar
  9. Calnan, M., Rowe, R.: Trust in Health Care: An Agenda for Future Research. The Nuffield Trust, London (2004)Google Scholar
  10. Carter, M.A.: Ethical Analysis of Trust in Therapeutic Relationships. University of Michigan Press, Ann Arbor (1989)Google Scholar
  11. Caterinicchio, R.P.: Testing plausible path models of interpersonal trust in patient-physician treatment relationships. Sci. Med. 13A, 81–99 (1979)Google Scholar
  12. Coleman, J.: Social capital in the creation of human capital. Am. J. Sociol. S95 (1988)Google Scholar
  13. Doescher, M.P.: Racial and ethnic disparities in perceptions of physician style and trust. Arch. Fam. Med. 9, 1156–1163 (2000)CrossRefGoogle Scholar
  14. Ensminger, J.: Reputations, trust, and the principal agent problem. In: Cook, K. (ed.) Trust in Society, pp. 185–202. Russell Sage Foundation, New York (2001)Google Scholar
  15. European Commission. Directorate-General for Communication.: Special Eurobarometer 411. Patient Saf. Qual. Care (2014). doi: 10.2772/33467,
  16. Freedman, L.P.: Achieving the MDGs: Health System as Core Social Institutions. Development 48, 19–24 (2005)CrossRefGoogle Scholar
  17. Fukuyama, F.: Trust: Social Virtues and the Creation of Prosperity. Free Press, New York (1995)Google Scholar
  18. Gambetta, D.: Trust: Making and Breaking Cooperative Relations. Blackwell, New York (1988)Google Scholar
  19. Giddens, A.: Risk, trust, reflexivity. In: Beck, U., Giddens, A., Lash, S. (eds.) Reflexive Modernization: Politics, Tradition, and Aesthetics is the Modern Social Order, pp. 194–197. Polity Press, Cambridge (1994)Google Scholar
  20. Gifford, S.: The meaning of lumps: a case study of the ambiguities or risk. In: Nettleton, S., Gustafsson, U. (eds.) The Sociology of Health and Illness, pp. 211–222. Reader Polity, Cambridge (2002)Google Scholar
  21. Gilbert, T.P.: Impersonal trust and professional authority: exploring the dynamics. J. Adv. Nurs. 49, 568–577 (2005)CrossRefGoogle Scholar
  22. Gilson, L.: Editorial: building trust and value in health systems in low- and middle-income countries. Soc. Sci. Med. 61(7), 1381–1384 (2005)CrossRefGoogle Scholar
  23. Gilson, L.: Trust and the development of health care as a social institution. Soc. Sci. Med. 56(7), 1453–1468 (2003)CrossRefGoogle Scholar
  24. Good, D.: Individuals, interpersonal relations, and trust. In: Gambetta, D. (ed.) Trust: Making and Breaking Cooperative Relations, pp. 31–48. Basil Blackwell, New York (1988)Google Scholar
  25. Goold, S.D., Klipp, G.: Managed care members talk about trust. Soc. Sci. Med. 54, 879–888 (2002)CrossRefGoogle Scholar
  26. Gray, B.H.: Trust and trustworthy care in the managed care era. Health Aff. 16, 34–49 (1997)CrossRefGoogle Scholar
  27. Hall, M.A., Zheng, B., Dugan, E., Camacho, F., Kidd, K.E., Mishra, A., Balkrishnan, R.: Measuring patients’ trust in their primary care providers. Med. Care Res. Rev. 59(3), 293–318 (2002)Google Scholar
  28. Hardin, R.: Trust. Polity Press, Cambridge (2006)Google Scholar
  29. IRES, Institutul Român pentru Evaluare și Strategie.: După referendum. Efecte ale crizei politice (2014).—efecte-ale-crizei-politice.pdf
  30. IRS, International Research Institutes, Global Health Survey.: Experience and perception in 28 countries (2011).
  31. Irwin, A., Michael, M.: Science, Social Theory and Public Knowledge. Open University Press, Maidenhead (2003)Google Scholar
  32. Kao, A., Green, D.C., Davis, N.A., Koplan, J.P., Cleary, P.D.: Patient’s trust in their physicians: effects of choice, continuity, and payment method. J. Gen. Intern. Med. 13, 681–686 (1998)CrossRefGoogle Scholar
  33. Kraetschrner, N., Sharpe, N., Urowitz, S., Deber, R.B.: How does trust affect patient preferences for participation in decision making? Health Expect. (2004).
  34. Lewis, J.D., Weigert, A.J.: The social dynamics of trust: theoretical and empirical research, 1985–2012. Soc. Forces 91(1), 25–31 (2012)Google Scholar
  35. Luhmann, N.: Trust: Making and breaking cooperative relations. In Gambetta, D. (ed.) Familiarity, Confidence, Trust: Problems and Alternatives, pp. 94–107. Basil Blackwell, New York (1988)Google Scholar
  36. Lynn-Mc Hale, D.J., Deatrick, J.A.: Trust between family and health care provider. J. Fam. Nurs. 6(3), 210–230 (2000)CrossRefGoogle Scholar
  37. Mainous, A.G., Baker, R., Love, M.M., Pereira Gray, D., Gill, J.M.: Continuity of care and trust in one’s physician: evidence from primary care in the US and the UK. Fam. Med. 33(1), 22–27 (2001)Google Scholar
  38. McKinlay, J.B., Marceau, L.D.: The end of the golden age of doctoring. Int. J. Health Serv. 32, 379–416 (2002)CrossRefGoogle Scholar
  39. McKnight, D.H., Chervany, N.L.: Trust and distrust definitions: one bit at a time. In: Falcone, R., Singh, M., Tan, Y.-H. (eds.) Trust in Cyber-Societies, pp. 27–54. Springer, Berlin, Heidelberg (2001)Google Scholar
  40. Mechanic, D., Schlesinger, M.: The impact of managed care on patients’ trust in medical care and their physicians. J. Am. Med. Assoc. 275, 1693–1697 (1996)CrossRefGoogle Scholar
  41. Mechanic, D.: Changing medical organization and the erosion of trust. Milbank Q. 74, 171–189 (1996)CrossRefGoogle Scholar
  42. Mechanic, D.: Trust in the provision of medical care. J. Health Polit. Policy Law 23(411), 661–686 (1998)CrossRefGoogle Scholar
  43. Messick, D., Kramer, R.: Trust as a form of shallow morality. In: Cook, K. (ed.) Trust in Society, pp. 89–119. Russell Sage Foundation, New York (2001)Google Scholar
  44. Meyer, S., Ward, P., Coveney, J., Rogers, W.: Trust in health system: an analysis and extension of the social theories o Giddens and Luhmann. Health Sociol. Rev. 17, 177–186 (2008)CrossRefGoogle Scholar
  45. Nooteboom, B.: Trust as governance device. In: Casson, M., Godley, A. (eds.) Cultural Factors in Economic Growth, pp. 44–68. Springer, Berlin (2000)CrossRefGoogle Scholar
  46. O’Neill, O.: A Question of Trust. The BBC Reith Lectures. Cambridge University Press, Cambridge (2002)Google Scholar
  47. Ouchi, W.: Theory Z. How American Business Can Meet the Japanese Challenge. Avon Books, New York (1981)Google Scholar
  48. Ozawa, S., Sripad, P.: How do you measure trust in health system? A systematic review of the literature. Soc. Sci. Med. 91, 10–14 (2013)CrossRefGoogle Scholar
  49. Parsons, T.: The Social System. Free Press, Glencoe, Ill. (1951)Google Scholar
  50. Pellegrino, E.D., Thomasma, D.C.: Fidelity to trust. In Pellegrino, E.C., Thomasma, D.C. (eds.) In the Virtues in Medicine, pp. 65–78. Oxford University Press, New York (1993)Google Scholar
  51. Popay, J., Bennett, S., Thomas, C., Williams, G., Gatrell, A., Bostock, L.: Beyond beer, fags, egg and chips? Exploring lay understandings of social inequalities in health. Sociol. Health Illn. 25, 1–23 (2003)CrossRefGoogle Scholar
  52. Putnam, R.D.: Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press, Princeton, NJ (1993)Google Scholar
  53. Putnam, R.D.: Bowling Alone: The Collapse and Revival of American Community. Simon and Schuster, New York (2000)CrossRefGoogle Scholar
  54. Rhodes, R., Strain, J.J.: Trust and transforming medical institutions. Camb. Q. Healthc. Ethics 9, 205–217 (2000)CrossRefGoogle Scholar
  55. Russell, S.: Treatment-seeking behavior in urban Sri Lanka: trusting the state, trusting private providers. Soc. Sci. Med. 61, 1396–1407 (2005)CrossRefGoogle Scholar
  56. Safran, D., Kosinski, M., Tarlov, A.R.: The primary care assessment survey: tests of data quality and measurement performance. Med. Care 36, 728–739 (1988)CrossRefGoogle Scholar
  57. Schwei, R.J., Kadunc, K., Nguyen, A.L., Jacobs, E.: Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups. Patient Educ. Couns. 16–21 (2014)Google Scholar
  58. Shapiro, A.K., Shapiro, E.: Patient-Provider relationships and the placebo effect. Strat. Health Enhancement 25, 317–383 (1983)Google Scholar
  59. Tarrant, C., Stokes, T., Baker, R.: Factors associated with patients’ trust in their GP: a cross-sectional survey. Br. J. Gen. Pract. 53, 798–800 (2003)Google Scholar
  60. Thom, D.H., Ribsil, K.M., Stewart, A.L., Luke, D.A.: Further validation and reliability testing of the trust in physician scale, the stanford trust study physicians. Med. Care 37(5), 510–517 (1999)CrossRefGoogle Scholar
  61. Thorne, S.E., Robinson, C.A.: Health care relationships: the chronic illness perspective. Res. Nurs. Health 11, 293–300 (1988a)CrossRefGoogle Scholar
  62. Thorne, S.E., Robinson, C.A.: Reciprocal trust in health care relationships. J. Adv. Nurs. 13, 782–789 (1988b)CrossRefGoogle Scholar
  63. Van der Schee, E, Groenewegen, P.P., Friele, R.D.: Public trust in health care: a performance indicator? J. Health Organ. Manage. 20(5), 468–76 (2006)Google Scholar
  64. Wang, M.C., Kim, S., Gonzalez, A.A., MacLeod, K.E., Winkleby, M.A.: Socioeconomic and food-related physical characteristics of the neighborhood environment are associated with body mass index. J. Epidemiol. Community Health 61, 491–498 (2007)CrossRefGoogle Scholar
  65. WHO: Everibody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. WHO, Geneva (2007)Google Scholar
  66. WHO: Primary Health Care-Now More Than Ever. WHO, Geneva (2008)Google Scholar
  67. Zucker, L.G.: Production of trust: institutional sources of economic structure, 1840–1920. In: Staw, B.M., Cummings, L.L. (eds.) Research in Organizational Behavior, pp. 53–111, vol. 6. JAI Press, Greenwich, CN (1986)Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Alexandru Ioan Cuza University of IașiIașiRomania

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