Americans' confidence in the health system as a whole is declining, but experts believe it could be rebuilt.
A recent survey by Johns Hopkins University found that public confidence in the US healthcare system has declined from 71.5% in 2020 to 40.1% in 2024. There are also a variety of studies showing that distrust is particularly rapidly rising in marginalized communities due to years of disparities in access and treatment outcomes, exacerbated by experiences of discrimination like medical experiments and historical injustice.
When trust in the healthcare system is eroded, experts say that rebuilding it requires both payers and providers to prioritize empathy, transparency and personalized communications.
What factors affect patient trust?
Research released last week by the AMF Media Group and The Medical Group Management Association (MGMA) found that public confidence in the entire US health system has declined, but most of the reasons people cite because of distrust have nothing to do with providers.
The report is based on survey responses from 2,400 US adults across a variety of socioeconomic backgrounds. When asked what undermined trust in the healthcare system over the past five years, respondents identified the impact of insurers, pharmaceutical companies and governments as key contributors to the decline in trust. In particular, the Covid-19 pandemic and vaccine efficacy have not been commonly cited as a factor in the decline in trust despite the widespread attention of these issues received over the past few years.
When asked what was reliable, respondents cited cultural relevance as an important factor. This is especially true for black patients and Hispanic patients.
When it comes to patient trust, providers are caught up in mating, said Andrew Swanson, MGMA's chief revenue officer.
They sit at the intersection of patients, insurance companies and pharmaceutical companies. And even without control of those systems, Swanson explained, often absorbs complaints about the cost of patients and lack of compensation.
He said MGMA recently held a meeting with around 50 provider executives on how to tackle the issue. Some executives suggested that hospitals and clinics start having more open and honest dialogues with patients about how uncertain and difficult it is for patients to navigate their care journey, he said.
“We have to give them advice and advice, but we can't tell them what to do. It takes patience. I think what healthcare organizations really have to own is that they need to have these conversations, whether they want to run an insurance company or not.
Overall, the survey data showed that patients wanted empathetic care providers and wanted them to take their time to treat them like individuals, he added.
Provider days are so busy that they sometimes unintentionally escape as cold or pleasant things. For example, the patient portal now has immediate access to lab and imaging results for people, Swanson noted. In some cases, patients may access these records before they have the opportunity to talk to their doctor.
“We don't want to be transparent. We want to inform people, but they need to give it with careful, empathy and knowledgeable narration to understand the outcomes they are getting,” Swanson said.
Support for cultural and linguistic diversity is also important, he said.
Cultural awareness training alone is not enough, Swanson warned. Providers need practical resources such as bedside translation services and visual reminders posted in the room to help them communicate sensitively with diverse patient populations, especially during busy clinical days.
How healthcare leaders can better understand the erosion of trust
Mark Lomax, CEO of healthcare software startup PEP Health, has made it difficult to improve patient trust without a reliable way to measure it. Measurements allow providers to take immediate steps to rebuild it by identifying when and where trust is eroding, he said.
Last week, PEP began its “trust score.” This is a real-time metric that quantifies trust by using AI to analyze patient feedback across the Internet. The tool analyzes 40 million unsolicited patient comments from sources such as social media, online reviews, and patient forums. This represents about one American, Lomax said.
Unlike traditional surveys that are slower and usually have lower response rates, confidence scores utilize actual, unfiltered patient feedback, he noted.
Startups are based on academic research scores, particularly on a “rising” model of trust, including logic, reliability and emotional connections as core pillars. Lomax said trust would disappear if any of these elements collapsed.
The goal of PEP was to use natural language processing AI to codify trust using these concepts.
The company's AI analyzes trust drivers and metrics, Lomax noted. Drivers are specific qualities that patients refer to providers in feedback, such as kindness and active listening. Indicators are observable patient behaviors that occur as a result of trust, such as patient retention and gratitude. Patients can clarify these types of behavior by writing “I've seen Dr. X for five years” or “I'm so happy that Dr. X took me a long time to answer all my questions.”
All of these factors are mapped onto the dashboard, forming a “real-time 3D trusted photo.”
PEP's Trust Score Dashboard (available for both providers and payers) analyzes trust across health systems, service lines, geographical regions and time. The score is on a scale of 1-5, with 3 being neutral points. A score below 3 means more negative than positive emotions.
An internal analysis of PEP determined that a 1-point loss of confidence could result in more than $12 million in annual revenues for large healthcare systems.
A study by Deloitte found that providers with higher patient-reported experience scores performed financially better than those with lower scores. Specifically, hospitals whose patients are rated as “excellent” had an average net profit of 4.7%, while hospitals with low ratings were 1.8%.
Lomax pointed out that PEP's tools are customizable. Users can adjust their dashboards to view data by geography, benchmark with peers, or analyze trust in a particular clinical area.
For example, ECU Health in North Carolina has worked with PEP to develop trust dashboards for each market area based on the interests of Julie Kennedy Oehlert, Chief Experience Officer of Health System. The ECU is one of several healthcare systems in the United States that pilot trust scores, Lomax said.
“Trust is the foundation of the relationship between health care and what they serve. If trust exists in a relationship, patients adhere to the treatment plan, seek medical care when necessary, and have candid conversations with care teams that are essential to their health plan,” Oehlert said in a statement. “This trust affirms burnout and promotes the passion and purpose of those who provide care.”
She also noted that the trust scores have a lower confidence score for providers to add another metric for them to manage and achieve a deeper understanding of patient relationships that play a key role in overall health outcomes.
How effective communication can help you increase your trust?
Effective communication is an important part of the provider and payer puzzle that aims to improve the level of trust among patients and members, says Bob Farrell, CEO of Healthcare Engagement Platform Mpulse.
“We see progressive organizations do a better job either repairing trust or building new trust by using digital engagement techniques to provide literacy, tailored touchpoints and details along the patient's healthcare journey.
Americans are increasingly hoping to take part in healthcare, Farrell noted. They have more tools and information than ever before, but they usually come from sources like social media and ChatGpt, not health plans or providers.
Farrell noted that there is an opportunity for healthcare institutions to use data analysis and AI to determine the best way to engage with a particular patient or member based on health and demographic profiles.
“If you're a 72-year-old man with diabetes and has had two falls in the last 24 months, you'll have a very different profile than a 32-year-old woman dealing with prenatal and early childhood issues.
Personalization helps people build trust because it helps them feel more understood, Farrell said. He explained that when payers or providers apply the same approach to very different groups, it can feel polished and impersonal.
When outreach is personalized, engagement rates can be significantly improved, sometimes jumping from the low single digits to the 20-30% range, says Farrell.
He also emphasized the importance of delivering content that reflects users' everyday digital experiences, such as Instagram-style video streaming, and said this could increase acceptability.
To rebuild trust, healthcare leaders need to realize that patients don't just want lab results or answers to facts. Experts agree that to make patients feel this way, providers and payers need to adopt a human approach centered around empathy and customized communication.
Photo: Porcorex, Getty Images
