title: A qualitative study of patient (dis)trust in public and private hospitals: the importance of choice and pragmatic acceptance for trust considerations in South Australia.
abstract: BACKGROUND
  This paper explores the nature and reasoning for (dis)trust in Australian public and private hospitals. Patient trust increases uptake of, engagement with and optimal outcomes from healthcare services and is therefore central to health practice, policy and planning.
  
  
  METHODS
  A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals).
  
  
  RESULTS
  'Private patients' made active choices about both their hospital and doctor, playing the role of the 'consumer', where trust and choice went hand in hand. The reputation of the doctor and hospital were key drivers of trust, under the assumption that a better reputation equates with higher quality care. However, making a choice to trust a doctor led to personal responsibility and the additional requirement for self-trust. 'Public patients' described having no choice in their hospital or doctor. They recognised 'problems' in the public healthcare system but accepted and even excused these as 'part of the system'. In order to justify their trust, they argued that doctors in public hospitals tried to do their best in difficult circumstances, thereby deserving of trust. This 'resigned trust' may stem from a lack of alternatives for free health care and thus a dependence on the system.
  
  
  CONCLUSIONS
  These two contrasting models of trust within the same locality point to the way different configurations of healthcare systems, hospital experiences, insurance coverage and related forms of 'choice' combine to shape different formats of trust, as patients act to manage their vulnerability within these contexts.
authors.affiliation: Discipline of Public Health, Flinders University, Room 2.10, level 2, Health Science Building, Registry Road, Bedford Park, 5042,, Adelaide, SA, Australia. Paul.ward@flinders.edu.au.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ward
authors.affiliation: School of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, Australia. Philippa.rokkas@flinders.edu.au.
authors.forename: Philippa
authors.initials: P
authors.lastname: Rokkas
authors.affiliation: Discipline of Public Health, Flinders University, Room 2.10, level 2, Health Science Building, Registry Road, Bedford Park, 5042,, Adelaide, SA, Australia. Clinton.cenko@flinders.edu.au.
authors.forename: Clinton
authors.initials: C
authors.lastname: Cenko
authors.affiliation: Discipline of Public Health, Flinders University, Room 2.10, level 2, Health Science Building, Registry Road, Bedford Park, 5042,, Adelaide, SA, Australia. Mariastella.pulvirenti@flinders.edu.au.
authors.forename: Mariastella
authors.initials: M
authors.lastname: Pulvirenti
authors.affiliation: Flinders Medical Centre, Adelaide, Australia. Nicola.dean@health.sa.gov.au.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dean
authors.affiliation: Flinders Medical Centre, Adelaide, Australia. Simon.carney@health.sa.gov.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Carney
authors.affiliation: Department of Sociology, University of Amsterdam, Amsterdam, Netherlands. P.r.brown@uva.nl.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.affiliation: School of Sociology, University of Kent, Kent, UK. M.w.calnan@kent.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Calnan
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. Samantha.meyer@uwaterloo.ca.
authors.forename: Samantha
authors.initials: S
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003695:Delivery of Health Care; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D011639:Public Opinion; D036301:Qualitative Research; D013021:South Australia; D035502:Trust