Individual perceptions of equity in the context of institutional and interpersonal trust in medicine by the older

The article examines individual perceptions of older people about fairness in the health care system through the prism of institutional and interpersonal trust. The empirical base of the study includes 40 semi-structured interviews with residents of St. Petersburg and rural areas of the Republic of Karelia aged 66-85. The results obtained allowed us to identify markers within the framework of the analysis of institutional and interpersonal trust that characterise similarities and differences in attitudes to the health care system among the considered category of citizens. The common markers of institutional trust for all respondents are the availability of modern equipment and competent staff. Older people in rural areas show significant distrust in local medicine, preferring ambulance services as a more reliable channel for receiving quality medical care. Attitudes towards the status of and trust in medical institutions vary significantly depending on the place of residence. Common interpersonal markers of trust include the presence of interactions and contacts with doctors and minimisation of bureaucratised communication. The integration of medical workers into the rural community and neighbourly help, which mitigated distrust in rural medicine and its possible problems, also proved to be important for rural residents. The study showed that individual perceptions of fairness were quite strongly influenced by trust in health care, and lack of trust affected older people's understanding of fairness. The close relationship between objective characteristics of medical care and subjective perception of its fairness requires the development of differentiated approaches to improving the health care system, taking into account regional peculiarities.