Predictors of trust in national healthcare systems in 22 EU/OECD countries

Abstract Background Individuals who have a high level of trust in their country's healthcare system are more likely to participate in screening programmes and to adhere to medical advice. In contrast, individuals with a low trust level tend to experience worse health outcomes, including lower satisfaction with care, increased morbidity and mortality. This study examines the level of trust in healthcare systems in EU and OECD countries and identifies predictors associated with high levels of trust. Methods Data came from the 2021 International Social Survey Programme. The sample included representative data from 29,382 adults in 22 EU/OECD countries. Sociodemographic variables, experiences and perceptions of the healthcare system (including barriers to access and efficiency), experiences with doctors and health status were considered. Hierarchical logistic regression analyses were performed. Results Countries differ in how many people have a high level of trust in their healthcare system (ranging from 12.5% in Poland to 82.7% in Norway). Individuals with higher levels of education tend to have more trust in the healthcare system. Trust is lower when the healthcare system is perceived as inefficient, when people believe that certain social groups are given preferential access to services, and when people do not believe that they will receive the best treatment if they fall ill. A negative perception of vaccinations and doctors, as well as personal experiences with barriers to access, are also associated with lower trust. Individuals who rate their health as excellent are more likely to have high levels of trust in the healthcare system compared to those who rate their health as poor (OR: 2.0). Conclusions The study shows that trust in the healthcare system is associated with various attitudes, experiences, and sociodemographic characteristics, as well as subjective health status. Key messages • Trust in the healthcare system is associated with health-promoting behaviour and positive outcomes. • Perceptions of inequality and experiences with barriers to access are associated with lower trust in the national health system.