Americans’ trust in the healthcare system is declining. How to repair it?

Americans are decreasing in their entire health care system — but experts believe it can be rebuilt.

Public trust in the U.S. health care system has dropped from 71.5% in 2020 to 40.1% in 2024, according to a new study from Johns Hopkins University. There are also various studies that distrust in marginalized communities is particularly rapid due to long-term differences in visits and treatment outcomes, exacerbated by experiences of discrimination and historical injustice (such as medical experiments).

With trust in the healthcare system, experts say rebuilding it will require payers and providers to prioritize empathy, transparency and personalized communication.

What factors affect the trust of patients?

Public trust in the overall healthcare system in the U.S. is declining, according to a study released last week by the AMF Media Group and the Medical Group Management Association (MGMA) — but most of the reasons for distrust are not relevant to providers.

The report is based on a survey of 2,400 American adults in a variety of socioeconomic contexts. When asked what weakened trust in the health care system over the past five years, respondents believed that the impact of insurance companies, pharmaceutical companies and governments were the main contributors to the decline in trust. It is worth noting that despite the widespread concern of these issues over the past few years, the pandemic of the Common 19-19 and the efficacy of the vaccine have not been considered a factor of weakening trust.

When asked what could improve trust, respondents viewed cultural relevance as an important factor, especially for Black and Hispanic patients.

Andrew Swanson, chief revenue officer of MGMA, said the provider was caught in terms of patient trust.

They sit at the intersection of patients, insurance companies and pharmaceutical companies – them Swanson explains that patients often feel frustrated with cost and lack of transparency in coverage, even if they can’t control these systems.

He noted that MGMA recently held a meeting with about 50 provider directors on how to solve the problem. He said some executives advised hospitals and medical offices to start a more open and honest conversation with patients about the uncertainty and difficulties of taking their nursing journey.

“We have to give them advice and consulting, but we can't tell them what to do. I think, what healthcare organizations really have, they're going to have these conversations, whether they want to own them or not. They don't run an insurance company. They don't run an insurance company, so it's not their business that is their business, and they're going to tell the insurer how they interact with the insurer because what they do with their interactions, but they turn down their commissions, and they're going to have a certain amount of treatment.

Overall, survey data suggest that patients need understanding care providers and spend time treating them like individuals.

With providers’ days so busy, sometimes they will unintentionally stand out or consciously. For example, Swanson noted that, for example, the patient portal now has immediate access to their lab or imaging results. In some cases, patients may access these records before having the opportunity to speak with their doctor, which can lead to unnecessary trouble and break down trust.

“We don't want to be opaque. We want to provide people with their information, but need to be cautious, empathetic and knowledgeable voiceovers so that they understand what they get,” Swanson said.

Support for cultural and linguistic diversity is also crucial, he said.

Swanson warned that training on cultural awareness alone is not enough. He explained that providers need practical resources (such as bedside translation services and visual reminders posted in the room) to help them sensitive to a diverse patient population, especially on busy clinical dates.

How healthcare leaders better understand the erosion of trust

Mark Lomax, CEO of Healthcare Healthcare Softs launches PEP Health, said it would be difficult to improve patient trust without a reliable way to measure it. He said the measurement enables providers to determine where the letter erodes any time so that they can take immediate steps to rebuild it.

Last week, PEP launched its “trust score,” a real-time metric that quantifies trust by analyzing patient feedback across the Internet using AI. Lomax said the tool analyzes 40 million unsolicited patient reviews from sources such as social media, online reviews and patient forums, accounting for about 1 in Americans.

He noted that traditional surveys may be slow and generally have lower response rates compared to traditional surveys, but lower trust scores have real, unfiltered patient feedback.

The startup’s score is based on academic research, especially the “rising” model of trust, which includes logic, authenticity, and emotional connections as its core pillars. If any of these elements break down, trust will disappear, Lomax said.

The goal of PEP is to use natural language processing AI to codify trust using these concepts.

Lomax notes that the company's AI analyzes trust drivers and metrics. The driver is the patient mentioning a specific qualities of his provider in feedback, such as kindness or active listening. Indicators are observable patient behaviors that occur due to trust, such as patient retention or gratitude. Lomax explains that patients can reveal these behaviors by writing them down, such as “I’ve seen Dr. X for five years” or “I’m glad Dr. X took the time to answer all my questions,” Lomax explains.

All of these factors are drawn on the dashboard, forming a “real-time 3D trust picture.”

PEP's trust score dashboard (which can be used by both providers and payers) analyzes trust across health systems, service lines, geographic areas and time. The score is 1-5, and the neutral score is 3. Scores below 3 mean more than positive emotions.

Internal analysis of PEP determines that a single point decline in trust could lead to annual revenue of larger health systems exceeding $12 million.

A Deloitte study also found that experienced providers with higher ratings performed better financially than those with lower scores. Specifically, the average net profit margin for hospitals rated as “Excellent” was 4.7%, while the lower-rated hospitals were 1.8%.

Lomax notes that Pep's tools are customizable. Users can tailor the dashboard to view data through geographic location, target peers with benchmarks or analyses trust in specific clinical areas.

For example, ECU Health in North Carolina teamed up with PEP to develop trust dashboards by market area, driven by the interests of Julie Kennedy Oehlert, chief experience officer of health systems. The ECU is one of the few U.S. health systems that are driving trust scores, Lomax said.

“Trust is the basis of the relationship between health care and the people they serve. When trust exists in the relationship, patients adhere to treatment plans, seek medical care when needed, and have a candid conversation with their care team, which is essential to their health plans,” Oehlert said in a statement. “This trust also adds enthusiasm and purpose to the enthusiasm and purpose of those who provide care, insulation to avoid burnout.”

She also noted that trust scores are less than adding another metric for the provider to manage, and that more understanding of the patient relationship plays an important role in overall health.

How more effective communication can help strengthen trust

Bob Farrell, CEO of healthcare engagement platform MPULSE, said effective communication is a key part of providers and payers who want to increase the level of trust in patients and members.

“We’re seeing progressive organizations do a better job of repairing trust or building new trust by using digital engagement technology to provide literacy capabilities, tailored touchpoints and details on the patient’s healthcare journey to help them feel like a program or provider to understand their experiences.”

Farrell notes that Americans increasingly want to be active participants in their healthcare. They have more tools and information than ever before – but usually from sources like social media and CHATGPT, not their health plans or providers.

Farrell notes that healthcare institutions have the opportunity to use data analytics and AI to determine how best to interact with specific patients or members based on their health and demographic profiles.

“If you are a 72-year-old man with diabetes and have two falls in the last 24 months, you will have a very different image from a 32-year-old woman who is dealing with prenatal and early childhood issues. You have to interact with these people correctly,” he said.

Farrell said personalization helps build trust because it helps people feel more understanding. He explained that when the payer or provider takes the same approach to very different groups of people, it feels grinding and impersonal.

Farrell said that when outreach activities are personalized, participation rates are greatly improved, sometimes jumping from low-unit numbers to the range of 20–30%.

He also stressed the importance of delivering content to reflect users’ daily digital experiences, such as Instagram-style video delivery, saying this could improve acceptance.

To rebuild trust, healthcare leaders need to recognize that patients want more than just lab results and factual answers – they want to feel seen, heard and supported in some of the most difficult moments of their lives. Experts agree that in order for patients to feel this way, providers and payers need to adopt a human approach centered on empathy and tailored communication.

Photo: Pig, Getty Images