Trust, risk and health care reform

Abstract

Across the developed world, governments face severe challenges in health care reform as demand rises and resource constraints grow more stringent. In the UK, the current government is devoting considerable resources to welfare state reform and (arguably) achieving real improvements in services such as the NHS and education. Despite this, the reforms remain highly controversial and there is considerable concern about lack of trust in the new welfare policies. A decline in trust may undermine the public acceptability of the reforms and threaten the ability of government to gain electoral support for them. Recent work in sociology, political science and psychology indicates that rational deliberative and non-rational valued-based or affective factors contribute to trust in institutions. At the same time, theoretical arguments suggest an increasing need for public trust. Trust facilitates the co-ordination of complex enterprises under conditions of uncertainty, especially valuable at a time when rising demand and intensifying pressures for spending constraint provide a continuing impetus for reform. One possibility is that policies designed within a rational actor framework may erode the non-rational aspects of trust, so that the service improves but trust in it declines, with consequences for the political sustainability of reformed health care systems. Risk research in health care has a good opportunity to consider issues of institutional trust and to build inter-disciplinary links in doing so.

Keywords:

• Trust
• risk
• rationality
• interdisciplinarity
• NHS
• reform