The Role of Institutional Trust in European Healthcare Evaluations—A Comparison of Absolute and Relative Healthcare Attitudes During the COVID‐19 Pandemic

ABSTRACT As with other social protection systems, healthcare represents a public institution that promises security in critical times. Thus, during the COVID‐19 crisis, trust became a crucial resource when people believed their health was at risk. The possible link between welfare state institutions and trust has been a popular research topic in recent decades, but the connection between healthcare evaluations and trust is underexplored. This study examines the connection between absolute and relative healthcare attitudes and institutional trust, which is assumed as a link between citizens' healthcare evaluations and their individual risks and resources, and the institutional framework they are exposed to. The study assessed healthcare evaluations in relative terms (relative to citizens' views about the performance of other national public institutions) and absolute terms, which offer new insights about how institutional trust connects to the individual and national level variations in healthcare attitudes. The 10th round of the European Social Survey data set ( N = 37,987, countries N = 27) was utilised, analysing it with multilevel fixed effects models. The results indicate that institutional trust functions as an important link between healthcare attitudes and institutional framework and individual risks and resources. Our findings showed that when the national cultural climate on evaluating societal institutions was accounted for, trust in political institutions explained country differences in healthcare attitudes. We also noted that greater financial resources put into welfare efforts increased healthcare satisfaction. Furthermore, better performance evaluations of national healthcare systems during COVID‐19 connected to better evaluations of healthcare systems in Europe.