Patients who trust their physician and the health care system are more likely to receive preventive care, have better self-rated health, and report greater satisfaction than those with lower trust.1,2,3 Researchers have posited that racial and ethnic differences in trust may be a factor causing disparities in health outcomes, since Black Americans have long reported lower trust than whites.2, 4, 5 We use a large, national sample to explore racial/ethnic and income-based disparities in health care–related trust, as the latter have received less attention.2, 4, 5

METHODS

We used data from the September 2018 Health Reform Monitoring Survey (n = 4946), which uses Ipsos’ KnowledgePanel, a nationally representative internet panel of English and Spanish speakers aged 18–64.6 To reach low-income respondents, Ipsos provides access to the internet and computers when needed.

Participants were asked how much they agreed or disagreed on a 5-point scale to statements affirming trust in four levels of the health care system: my personal doctor or health care provider (personal doctor), most doctors, most hospitals, the overall health care system. Trust in one’s personal doctor was only asked of those reporting a personal doctor.

We examined relationships between race/ethnicity (white (non-Latino), Black (non-Latino), Latino, and other), family income (≤ 138% FPL, 139–249% FPL, 250–399% FPL, and 400%+ FPL), and each trust variable, controlling for gender, age, health status, and having a disability. We estimated multinomial logistic regression models since the trust variables had multiple categories. We combined strongly and somewhat disagree because of limited responses, and for trust in one’s personal doctor, we combined neutral and disagree responses. Logistic regression was used to examine characteristics related to having a personal doctor. Analyses were weighted to be nationally representative and adjust for the sample’s complex design. Bivariate findings (available from authors) were consistent with multivariate results.

RESULTS

Trust was much higher for one’s personal doctor than for other levels of the health care system. Of the 63.2% of respondents who had a personal doctor, almost two-thirds (64.6%) strongly trusted (i.e., strongly agreed) their personal doctor (not shown). Less than half as many participants (24.2%) strongly trusted most doctors, and even fewer reported strongly trusting most hospitals or the health care system (19.9% and 16.0%, respectively).

Among those with a personal doctor, Blacks and Latinos did not differ significantly in their level of trust in their doctor compared with whites (Table 1). Latinos, though, were less likely to have a personal doctor than were whites (OR = .64). Those in the three lower income groups, however, were at least twice as likely not to trust (i.e., neutral or disagreed) their personal doctor as those in the highest income group (400%+ FPL). Additionally, respondents in the lowest two income groups had approximately half the odds of having a personal doctor compared to the highest income group.

Table 1 Key Regression Model Results for Having a Personal Doctor or Health Care Provider, and Trusting that Provider
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There were also income-based differences in trust in most doctors and most hospitals (Table 2). Those in the three lower income groups were 81–106% more likely to report not trusting (i.e., disagreed) most doctors compared to the highest income group. Similarly, those with lower incomes were substantially more likely (45–71%) to report not trusting most hospitals than were the highest income group. There were, in contrast, no significant differences in trust in most doctors or trust in most hospitals by race/ethnicity.

Table 2 Racial/Ethnic and Income-Based Differences in Trust in Most Doctors, Most Hospitals, and the Health Care System
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Income was not consistently related to trust in the health care system. While race/ethnicity was related, Blacks and Latinos were less likely to report not trusting the health care system than whites (RRR = .37 and RRR = .58, respectively).

DISCUSSION

Using a large, national survey, we found Blacks and Latinos did not significantly differ in their level of trust for their personal doctor, most doctors, or most hospitals compared to whites, and were actually slightly more trusting of the overall health care system than whites. However, lower income respondents had less trust in their personal doctor, most doctors, and most hospitals than did higher income respondents. Future research is needed to confirm these findings and to explore racial/ethnic differences within income groups.

This study’s findings underscore the importance of monitoring levels of health care-related trust, and highlight the need for health care providers and organizations to build trust with all patients, particularly those with lower incomes, which disproportionately includes minority populations.