中国公众对医疗卫生系统的信任及其影响因素研究

公众信任对医疗卫生系统运行的意义已经得到了广泛认可。发达国家在该领域已进行了大量实证研究，而我国尚未有公众对医疗卫生系统信任的研究。通过全国范围内的大样本调查，对我国公众对医疗卫生系统的信任及其影响因素进行分析，结果表明：我国公众对医疗卫生系统信任的比例为25.2%，远低于对地方政府和对社会上大多数人的信任水平;公众对地方政府的信任和对医疗服务的满意度是影响其对医疗卫生系统信任的最主要的因素。与其他国家相比，我国拥有较高的公众对各级政府的信任水平和最低的医疗服务满意度水平。如果没有较高水平的公众对地方政府信任的正向影响，我国公众对医疗卫生系统的信任状况将更加不容乐观。提高医疗服务满意度是提升我国公众对医疗卫生系统信任最为可行的政策措施。

Determinants of Public Trust in Health Care System in China

Public trust has long been recognized as crucial to the effective functioning of health care systems. In contrast to the abundant research in developed countries, there is no previous empirical study on public trust in health care systems in China. Moreover, health care system is one of the most dissatisfied public services in China, and the disturbingly high incidence of violent attacks against physicians and hospitals is the core problem in the operation of China's health care system, as well as an important social public issue in China. In addition, although the mistrust of the health care system has been inferred as the main cause of China's violence against physicians, there is no empirical evidence to be supported. Therefore, the primary objective of this study is to examine the level and determinants of public trust in China's health care system through a national survey in 26 provincial areas of China. The results show that public trust in China's health care system was 25.2%. Moreover, public trust in China's health care system was much lower than the trust in local governments, trust in most people in the society, and also lower than that of most of the countries or regions surveyed. Furthermore, satisfaction with most recent treatment experience was the lowest among the 29 countries surveyed. The results from the ordinal logistic regression model showed that respondents who had more trust in the local governments, had more trust in most people in the society, and were more satisfied with their most recent health care system experience were significantly more likely to trust the country's health care system. Moreover, the respondents who reported a higher level of happiness, positive attitudes towards social equity, and a higher level of self-identified social class were significantly more likely to trust in China's health care system. Furthermore, trust in local governments and satisfaction with most recent treatment experiences were the major determinants of public trust in China's health care system. Moreover, respondents who were older, had a lower annual income, and a higher education level had a higher probability of trusting China's health care system. In addition, the demographic variables explained few of the total variance of public trust in the health care system. In conclusion, public trust in China's health care system is low. Furthermore, the current low level of public trust in the health care system would be even lower if public trust in China's government were not so high. Therefore, Chinese policymakers should prioritize improving the health care system. Compared with the other determinants of public trust, improving experiences with health care treatment experiences appears to be not only the most urgent but also the easiest and most effective measure to improve trust in China's health care system.