Public Trust in Physicians-Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries

Abstract

Trust in physicians has declined, and surveys of public opinion show a poor level of public trust in physicians. Commodification of health care has been speculated as a plausible driving force. We used cross-national data of 23 countries from the International Social Survey Programme 2011 to quantify health care commodification and study its role in the trust that patients generally place in physicians. A modified health care index was used to quantify health care commodification. There were 34 968 respondents. A question about the level of general trust in physicians and a 4-item "general trust in physicians" scale were used as our major and minor outcomes. The results were that compared with those in the reference countries, the respondents in the health care-commodified countries were approximately half as likely to trust physicians (odds ratio: 0.47, 95% confidence interval [CI]: 0.31-0.72) and scored 1.13 (95% CI: 1.89-0.37) less on the general trust scale. However, trust in physicians in the health care-decommodified countries did not differ from that in the reference countries. In conclusion, health care commodification may play a meaningful role in the deterioration of public trust in physicians.

Keywords: commodification; health care commercialization; health care commodification; multilevel; patient trust; surveys and questionnaires; trust.

Figure 1.

The conceptual framework to explain how commodification may affect multiple dimension of trust through 3 intermediate factors (consumerism, conflict of interest, and risk of unmet care needs).

Figure 2.

Scatter plot and regression line of average score of patient trust and health care index.

Figure 3.

Estimated adjusted odds ratio (OR) of higher trust in physicians for health care–commodified countries compared with reference and decommodified countries conditioning on each level of household income. Note. The overall interaction effect of health care commodification (dichotomized into commodified and reference/decommodified countries) and household income was nonsignificant (P = .36). Bars represent 95% confidence intervals.