How confidence in health care systems affects mobility and compliance during the COVID-19 pandemic

Trust in the health care system requires being confident that suffic ient and appropriate treatments will be provided if needed. The CO VID-19 public health crisis is a significant, global, and (mostly) simultaneous test of the behav ioral implications arising from this trust. We explore whether populations reporting low l evels of confidence in the health care system exhibit a stronger behavioral reaction to th e COVID-19 pandemic. We track the dynamic responses to the COVID-19 pandemic across 38 countries and 621 regions by exploiting a large dataset on human mobility generated between February 15 and June 5, 2020 and a broad range of contextual factors (e.g. deaths or policy implementations). Using a time-dynamic framework we find that societies with low level s of health care confid ence initially exhibit a faster response with respect to staying home. However, this reaction plateaus sooner, and after the plateau it declines with greater magnitude than does the response from societies with high health care confidence. On the other hand, regions with higher confidence in the health care system are more likely to reduce mobility once the government mandates that its citizens are not to leave home except for essen tial trips, compared to those with lower health care system confidence. Regions with high trust in the govern ment but low confidence in the health care system dramatically reduce their mobility, sugges ting a correlation for trust in the state with respect to behavioral responses during a crisis.