Trust in functioning of health care services in Finland

Abstract Background Trust in the functioning of health care (HC) is crucial for the legitimacy of the public health care system. A decline in trust may lead to a reduced willingness among taxpayers to finance the system. This study examines the trends and correlates of trust in HC among the Finnish population. Methods Data from the Healthy Finland survey (2024, n = 26,628, aged 20+) were used, along with earlier surveys (2020, 2018,2022) to assess trends. Complex samples logistic regression was applied to analyze associations between independent variables (sociodemographics, self-rated health (SRH), mental health, HC use, and access barriers) and trust in HC. Results Trust in HC was reported by 79.8% (95% CI: 78.2-80.3) in 2018, 75.8% (CI: 75.0-76.5) in 2020, and 65.9% (CI: 65.5-66.3) in 2022 and 54.4% (CI: 53.5-55-4) in 2024. In the fully adjusted model (2024 data), higher trust was observed among frequent HC users (vs. no users OR = 1.62, CI: 1.43-1.83). Lower trust was reported by rural residents (vs. urban residents OR = 1.28, CI: 1.15-1.43)those with poor SRH (OR = 0.70, CI: 0.63-0.77), poor mental health (OR = 0.57, CI: 0.50-0.66), those experiencing poor service integration (OR = 0.66, CI: 0.60-0.74), long waiting times (OR = 0.63, CI: 0.56-0.70), high user fees (OR = 0.77, CI: 0.70-0.86), and long-distance access barriers (OR = 0.77, CI: 0.69-0.86). Initially, higher income was linked to stronger trust, but not in the fully adjusted model. Conclusions The results indicate a declining trend in trust in the functioning of HC services. Poor health status and difficulties in accessing services are linked to reduced trust. Measures to improve access to HC services are essential to strengthen the legitimacy of the system. Key messages • Trust in HC is declining. Poor health and access difficulties are linked to lower trust. • Improving access is vital to strengthening system legitimacy.