International variations in fiduciary and competence trust of physicians: A multilevel study

ABSTRACT This article examines how public trust in physicians varies across two primary dimensions: trust in physicians' technical competence and in their fiduciary duty to prioritise patients' interests above their own. While prior empirical studies explain variations in trust of physicians primarily by focusing on patients' individual characteristics, trust differences across national borders remain underexplored. This study utilises nationally representative survey data from 26 countries and data from national-level collections to investigate the correlates of both dimensions of trust. Multilevel ordinal logistic regression analysis reveals associations between the two dimensions of trust in physicians and a host of individual and national characteristics. The study reveals a complex relationship between trust and how countries fund health care delivery. Trust that physicians uphold their fiduciary duty to patients is significantly stronger in countries with predominantly tax-funded primary care systems. Conversely, both fiduciary trust and competence trust are weaker where out-of-pocket payments comprise a greater percentage of total health spending. Finally, individuals who report they are in better health are more likely to trust physicians.