The relationship between enrollees' perceptions of health insurers' tasks and their trust in them.

Background: Health insurers' role in healthcare systems based on managed competition comprises various tasks. Misconceptions about these tasks may result in low public trust, which may hamper health insurers in performing their tasks. This study examines the relationship between enrollees' perceptions of health insurers' tasks and their trust in them.

Methods: A questionnaire in November 2021 asked respondents to indicate to what extent health insurers have to perform certain tasks, whether they actually perform them, and whether they think these tasks are important. Trust was measured using a validated multiple-item scale. The results from 837 respondents (56 per cent response rate) were analysed using multivariate regression models.

Results: A larger mismatch between enrollees' expectations about health insurers' tasks and their actual statutory tasks is related to less trust regarding the categories 'controlling healthcare costs' and 'mediation and quality of care'. Second, a larger mismatch between expectations and actually performed tasks is related to less trust for all categories. Importance of tasks only affects this relationship concerning 'informing about price and availability of care'.

Conclusions: This study emphasises the importance of reducing enrollees' misconceptions as trust in health insurers is necessary to fulfil their role as purchaser of care.