General trust in the health care system and general trust in physicians: A multilevel analysis of 30 countries

This article builds upon a multilevel theory of trust to explore the relationship between general trust in health care systems and general trust in physicians and the social-contextual factors that shape this relationship. We develop a model of trust in physicians emphasizing the embeddedness of individuals in broader social-institutional contexts. We analyze data from 30 countries in the 2011 International Social Survey Program (N = 38,068) and specify hierarchical linear models with macro-micro level interactions. At the individual level, we find that individuals who trust the health care system are more likely to trust physicians in general. At the country level, we find that respondents from countries with predominately publicly financed health care systems are more likely to trust physicians than their counterparts in countries with less public funding of the health care system. Finally, we find that the greatest predicted probability of trust in physicians is found among individuals who trust their publicly funded health care system and the lowest probability is among individuals who have no confidence in their privately funded health care system. Based on these findings, we call for greater attention to the interaction of micro- and macro-level factors in models of trust in physicians cross-nationally.