Value importance and value congruence as determinants of trust in health policy actors☆
Introduction
The Canadian health care and health insurance system has come under scrutiny by other countries, especially the United States, as a potential model for reform in their systems. Within Canada, the province of Alberta has taken the lead in launching major reforms involving hospital closures, privatization, regionalization, and much more. Insights into the way in which major structural reform in Alberta has been received by Albertans, and factors shaping that reception, are potentially very useful to policy planners and political strategists who are considering major reforms in other jurisdictions. One important aspect of the public reception of reform is trust.
Trust has emerged as a major issue in a variety of institutional spheres in contemporary society (Fukuyama, 1995), including the health care system and its reform. Examples of egregious violation of trust relationships by individuals and institutions abound around the world and have transformed the landscape in terms of how some individuals relate to institutions in which such violations have occurred. Exit from, or hyper-vigilance toward, those institutions has been a common response to violations of trust. Yet, as Hirschman points out, there are some situations, including certain public services such as medical services, in which opting out in the face of a generalized loss of confidence in the traditional system either is not likely to be an adequate safeguard of the consumer's interests or is otherwise ‘dysfunctional’ (or too costly) to the system (Hirschman, 1980, pp. 436–438, 451). In such situations it is incumbent upon the architects of system reform and managers of the system not to lose the trust and confidence of their clientele.
The present paper has two main purposes. One is to identify the determinants of three different types of trust. Special attention is given to the role played by one of the values embodied in Canada's national health legislation, the Canada Health Act (Revised Statutes of Canada, 1985, cC-6, Sections 7–12), in determining the level of trust that individuals have in their health care system and in key actors in the health policy community. More specifically, we focus on the importance that the individual attaches to ‘equal accessibility’ (equal access to quality health care) and on the degree of congruence between the importance which the individual attaches to ‘equal accessibility’ and the importance that s/he perceives the provincial Premier and the Regional Health Authority (CRHA) attach to that value. Our interest in ‘equal accessibility’ is prompted by the findings of the National Forum on Health (1997), which found that “equality of access is one of the most important values consistently advocated” by Canadians. Our second purpose is to assess the contribution of value importance and value congruence relative to other variables identified in the trust literature.
Our data are from a 1999 survey of residents of Calgary, Alberta (a city of about 875,000 residents at the time of the study). The core of the paper consists of regression analyses in which the dependent variables are six measures of trust representing three different types of trust.
Section snippets
Review of the literature on trust and values
The literature on trust in institutions is dominated by an interest in political and governmental institutions. Articles addressing trust in health care players and medical institutions report merely levels of trust (Alberta RN, 1998; Elabdi, 1996; National Coalition on Health Care, 1997; Snow, 1997; Zussman, 1997), rather than determinants of trust. The exception is the extensive literature on interpersonal trust in the context of the doctor–patient or nurse-patient relationship.
Graves,
Data
After pre-testing, a five-page questionnaire containing 150 variables in the form of 30 questions was mailed to 995 randomly selected households in Calgary, Alberta, Canada on November 4, 1999. (This was less than 1 month after the provincial Premier first announced the provincial government's intention to introduce Alberta's controversial Health Care Protection Act—Bill 11—which allows for the expansion of private, for-profit surgical facilities in the province.) Eligibility to participate in
Dependent variables
The six dependent variables chosen for this analysis represent three different aspects of trust—generalized systemic trust in the health care system (one variable), fiduciary trust in health policy actors (two variables), and generalized trust in particular actors’ input to health system changes (three variables). Response categories were either on a 4-point or a 5-point Likert-type scale where higher scores indicate greater trust.
Question phraseology for the dependent variables is shown below,
Results
Multiple regression analysis offers the very attractive advantage of enabling us to ascertain the impact of any given independent variable on the dependent variable, holding constant the effect of all other variables in the analysis. The regression analysis for any given dependent variable was conducted with the independent variables being entered en bloc. In addition, blank cells in the tables below denote coefficients that were not statistically significant at the 0.05 level. Diagnostic tests
Discussion and conclusions
Our research (tables not shown) found moderate levels of trust in the Alberta medical system and surprisingly low levels of trust in key actors in the health policy field—namely, the provincial Premier, the provincial health department, and a ‘senior administrator in a regional health authority’. The Calgary Regional Health Authority and the Government of Alberta (not further specified) fared better, in terms of fiduciary trust invested in them by Calgarians. Levels of trust in these six
Acknowledgements
The research reported here was partially funded by grants from University of Calgary and from an individual who wishes to remain anonymous but who had no vested interest in the results. The authors express their sincere appreciation to the following persons for their valuable assistance: Dr. Tom Langford, Dr. Richard Wanner, Pam Weinberger, Susan Jenkins, Margaret MacLennan, and the anonymous reviewers.
References (23)
Interpersonal trust and attitudes toward human nature
- Alberta RN. (1998). Angus Reid poll finds Albertans believe health cuts have affected nursing care. Alberta RN, 55(2),...
- et al.
Individual-level evidence for the causes and consequences of social capital
American Journal of Political Science
(1997) - et al.
News frames, political cynicism, and media cynicism
Annals of the American Academy of Political and Social Science
(1996) - et al.
Trust in government
Albertans place trust in nurses
AARN Newsletter
(1996)TrustThe social virtues and the creation of prosperity
(1995)Social trust and human communities
(1997)- Graves, F. L., Beauchamp, P., & Herle, D. (1998). Research on Canadian values in relation to health and the health care...
Exit, voice, and loyaltyFurther reflections and a survey of recent contributions
Milbank Memorial Fund Quarterly/Health and Society
(1980)
Cited by (32)
Trust in times of health reform
2019, Health PolicyCitation Excerpt :Additionally, literature on attempts to increase trust between patients and doctors suggest that patient participation and shared decision-making only contributes to more trust if participation and shared decision-making are congruent with the values of patients [29]. Value congruence also seems to play a role in explaining public trust in the health care system and actors within the system [46] and might consequently be relevant in attempting to improve the trust relations between insurers on the one hand and insured and providers on the other hand. The strength of this article is that we studied trust in three relationships and where possible over time.
Determinants of trust in the flu vaccine for African Americans and Whites
2017, Social Science and MedicineCitation Excerpt :Rather than consider institutions and providers separately, a broader look at the vaccine process encompasses the interactions between the two. Studies have shown feelings of shared values between patient and provider can reinforce institutional trust (Gilson, 2003; Kehoe and Ponting, 2003). The reverse has also been observed, as trust at a larger system can serve as a foundation in a new trust relationship with an individual provider (Hall et al., 2001).
A qualitative approach to assess the alignment of Value Systems in collaborative enterprises networks
2013, Computers and Industrial EngineeringCitation Excerpt :Nevertheless, it can be intuitively understood that when the core values of one member are incompatible with the core values of another, there is a misalignment and the potential for conflict is high. Reciprocally, when the core values of one member are compatible with the core values of another member, there is an alignment and the potential for emergence of conflicts is low (Adkins, Ravlin, & Meglino, 1996; Jehn, Chadwick, & Thatcher, 1993; Kehoe & Ponting, 2003). Although, the existence of a total alignment does not imply the total elimination of conflicts, an assessment of the level of values alignment enables the causes for conflicts to be better understood and thus mechanisms may be designed for the progressive resolution of problems.
Empirical analysis of factors explaining local governing bodies' trust for administering agencies in community-based conservation
2012, Journal of Environmental ManagementCitation Excerpt :The rational assessments mechanism for trust can operate not only at the individual level but also at the organizational level. It is argued that individuals’ trust for organizations is dependent upon the constituents’ assessments of the organization’s ability to meet their needs (Kehoe and Ponting, 2003). At the individual level, there are benefits and costs associated with being a member of the committee, so it is expected that the committee members will have higher levels of trust if they perceive the benefits of being a member outweigh the costs.
Trust and The Acquisition and Use of Public Health Information
2022, Health Care Analysis
- ☆
Revision of paper presented at the Canadian Sociology and Anthropology Association Annual Meeting, Québec City, Québec, May 28, 2001.