Trust and Health Care-Seeking Behavior

Trust is widely viewed as central to health-care systems, yet trust in health care is not a single relationship: patients interact with and rely on multiple entities—providers, hospitals, insurers, and public health authorities—and trust in these components can differ sharply. We develop an economic framework in which care-seeking depends on beliefs about the usefulness of care, the expected disutility of care, and expectations about out-of-pocket costs and claim denials. Overall system trust is modeled as a CES aggregation of entity-specific trust, allowing trust components to act as complements or substitutes. Guided by the theory, we field a nationally representative U.S. survey measuring overall trust, trust in key entities, the model’s mechanisms, and both retrospective and prospective care-seeking behaviors. Higher trust is strongly associated with greater preventive and elective care-seeking and lower care avoidance, with magnitudes comparable to education and income gradients. Structural estimates imply that overall trust is relatively substitutable across health care entities, however within-domain trust components are more complementary, especially among individual providers (e.g., doctors and nurses). Counterfactual simulations show that losses of trust in different entities have different behavioral consequences, with trust in doctors playing the largest role. These findings highlight trust as a first-order correlate of care-seeking and show that the composition and aggregation of trust across health-care entities are central for understanding utilization and the effects of trust shocks.