Does distrust in providers affect health-care utilization in China?
How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents' hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence.
School of Social and Political Sciences, University of Glasgow, Glasgow G12 8RT, UK jane.duckett@glasgow.ac.uk.
Jane
J
Duckett
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, UK.
Kate
K
Hunt
School of Social and Political Sciences, University of Glasgow, Glasgow G12 8RT, UK.
Neil
N
Munro
Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK.
Matt
M
Sutton
D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002681:China; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D035502:Trust
China; Trust; clinics; utilization of health services