Public distrust in physicians and healthcare utilization: a nationwide study in China

BACKGROUND: Public distrust in physicians constitutes a significant barrier to effective healthcare utilization, particularly in China, where physician-patient tensions are well-documented. This study analyzed the association between public distrust in physicians and healthcare utilization in China. METHODS: Utilizing a longitudinal nationally representative dataset from the 2012-2022 China Family Panel Studies, the final sample consisted of 168,174 observations. This study employed a two-way fixed-effects logistic regression analysis within the framework of Andersen's Behavioral Model to examine the association between distrust and healthcare utilization, while controlling for predisposing characteristics, enabling resources, and need factors. RESULTS: Rural areas exhibited a higher outpatient service utilization rate than urban areas. Urban inpatient service utilization rates rose annually from 9.43% in 2012 to 12.36% in 2018, surpassing rural rates, before falling to 9.71% in 2022, below rural levels. Rural residents who reported higher levels of public distrust in physicians showed a lower odds of accessing outpatient care (OR: 0.98, 95% CI: 0.96-0.99). Urban residents who reported higher levels of public distrust in physicians showed a lower odds of accessing inpatient care (OR: 0.97, 95% CI: 0.95-0.99). CONCLUSION: Higher public distrust in physicians was associated with reduced outpatient care access among rural residents and diminished inpatient care access among urban residents. Improving physician-patient trust is a critical policy priority in China. Targeted policy interventions, including strengthening physician-patient trust in rural grassroots clinics, improving the quality of urban inpatient services, and promoting the balanced allocation of medical resources, are needed so as to narrow the urban-rural trust gap and promote the equitable and rational use of medical services.