Trust in Indian healthcare systems is probably an all-time low, going by the recent acts of violence against doctors in public hospitals. Indian healthcare system has consistently fallen short of almost all its goals, especially of improvements in the health status of the poor, the quality of care provided to them, and social and financial risk protection for them. This is not just true for public healthcare, but also for the private healthcare providers, who have been exposed regularly in the mainstream media indicating people’s growing frustration with corruption in the health system, and the failure of the government and professional associations to manage it. What’s key to notice here is the erosion of ‘trust’ in both public and private healthcare systems and in the regulatory institutions responsible for ensuring this ‘trust’. 

The recently released EY- FICCI’s report ‘Re-engineering Indian Healthcare 2.0’ indicates this growing mistrust among patients against healthcare providers. The report, based on an online survey of 1,000 patients across six geographical zones in India, reveals that 61 percent of patients believe that hospitals did not act in their best interests, as against 37 percent of patients from a similar survey by EY in 2016. 

Why trust is important in treatment?

Trust in healthcare services involves two questions: whether the physician and/or medical institutions are competent enough to provide proper diagnosis and treatment, and whether they’re acting in the best interest of the patient. Establishing this trust is critical because it bridges the vulnerability, uncertainty, and unpredictability inherent to the provision of healthcare.

The salience of this trust depends on the circumstances of patients, the extent of risk, the characteristics of their illnesses and needs, and their access to information and knowledge basis in which they can challenge a doctor’s prescription.


The shift in trust from public to private healthcare based on patients’ educational levels

With increasing population, the country’s supply-demand imbalance in healthcare, pervasive negligence of public institutions, deterioration in the quality of healthcare, and the overcrowding of public health facilities has led to a shift in patient’s trust in public healthcare to that in private healthcare over the last 2-3 decades. This shift, however, has been more pronounced with the change in patient’s education levels.

As per the India Human Development Survey (IHDS), conducted between 2005 and 2012, and use levels of confidence in doctors/hospitals as a proxy for patient-doctor/hospital trust, adults with high levels of education (11 years and more) are less likely to show high confidence in government healthcare, but more likely to in private healthcare, relative to those with lower levels of education (6-10 years).


The changing nature of trust in healthcare 

The rapid growth in technology in the medical field has resulted in major advances in the understanding of disease processes, and in the diagnosis, treatment, and course of diseases. The corporatization of medical care has driven the advancement of technology in medicine in India. People seeking healthcare have access to the internet for information. These developments have affected people’s trust in healthcare in various ways. 

As patients become increasingly able to make informed decisions, their trust in doctors may reduce as they start suspecting that doctors might be motivated by money more than they are by patients’ well-being. Thus, patients’ trust may no longer be blind trust. Patients may now choose to have calculated trust in which they make a calculated choice to trust the doctor. At the same time, some patients may believe that paying money buys them trustworthiness in the private health system, whereas the public system is not trustworthy since no money is paid.

The development of information technology has also given rise to readily verifiable trust. The patients have access to information and can verify the doctor’s decisions. Also, the growth of evidence-based medicine has also been a factor that has had an impact on patient-doctor trust. The evidence-based medicine movement is being seen as disrespecting the value of clinical experience and expertise. Its protocol-driven practices often ignore patient preferences and may increase healthcare costs. Patients develop trust in the standardized protocols and treatment procedures than in the physicians, leading to the trust becoming impersonal.


Correlation between Trust and Willingness to Pay

Patients today form their perception based on online information which can often be overwhelming, misleading, or simply incorrect. Physicians need to acquire enough knowledge on all the available medicines for a disease in order to prescribe the one that matches the affordability from the patient’s point of view. But even if the patient can afford the prescribed medication, until they are not convinced of its value, they may still be unwilling to pay. This value again is established if the trust is established. Trust, therefore, is essential to ensure the patients are willing to pay for the prescription they absolutely need to recover from their diseases.


The way forward

Without a doubt, there is a need to re-engineer the Indian healthcare ecosystem with ‘establishing trust’ as the key metric. Healthcare providers need to redesign their business models to ensure patient satisfaction with the services provided. They must emphasize building a strong positive emotional connect with patients, which eventually translates into trust. India has one of the lowest per capita healthcare spends and total and public healthcare expenditure as a percentage of GDP (0.34% in 2019-20 budget). Engaging private players for innovative primary care in remote locations, enabling indigenous production of cheaper generic and life-saving drugs and low-cost medical products will also be a step forward in establishing sustainability as well as higher trust in both public and private healthcare systems.