Katie Adams , 2025-05-08 18:30:00
Americans’ trust in the overall healthcare system is dwindling — but experts believe it can be rebuilt.
Public trust in the U.S. healthcare system fell from 71.5% in 2020 to 40.1% in 2024, according to recent research from Johns Hopkins University. There are also various studies showing that feelings of distrust are rising particularly quickly in marginalized communities due to longstanding disparities in access and treatment outcomes, compounded by experiences of discrimination and historical injustices like medical experimentation.
As trust in the healthcare system erodes, experts say that rebuilding it will require both payers and providers to prioritize empathy, transparency and personalized communication.
What factors influence patient trust?
The public’s trust in the overall U.S. healthcare system is declining — but most of the reasons people cite for distrust don’t have to do with providers, according to research released last week by AMF Media Group and the Medical Group Management Association (MGMA).
The report is based on survey responses from 2,400 U.S. adults across a wide variety of socioeconomic backgrounds. When asked what has weakened their trust in the healthcare system in the past five years, respondents identified the influence of insurers, pharmaceutical companies and the government as the major contributors to declining trust. Notably, the Covid-19 pandemic and vaccine efficacy were not commonly cited as factors in the waning of trust, despite the widespread attention these issues received in the last few years.
When asked what can improve trust, respondents cited cultural relatability as an important factor, with this being especially true for Black and Hispanic patients.
When it comes to patient trust, providers are caught in the crosshairs, said Andrew Swanson, chief revenue officer at MGMA.
They sit at the intersection of patients, insurers and pharmaceutical companies — and they often absorb patients’ frustration over costs and lack of coverage transparency, even though they don’t control those systems, Swanson explained.
He noted that MGMA recently held a meeting with about 50 provider executives about how to tackle this problem. Some of the executives suggested that hospitals and medical offices start having more open and honest dialogues with patients about how uncertain and difficult it can be for them to navigate their care journeys, he said.
“We have to give them advice and counsel, but we can’t tell them what to do. We need patience. I think what healthcare organizations really have to own is that they are going to have these conversations, whether they want to have them or not. They’re not running the insurance company, so it’s not their business to tell insurers what to do or to tell patients what to do about their interactions with insurance, but they have to be a sounding board for patients as they come in,” Swanson declared.
Overall, the survey data showed that patients want care providers who are empathetic and take the time to treat them like an individual, he added.
With providers’ days being so busy, they can sometimes unintentionally come off as cold or unfeeling. For example, patient portals now give people instant access to their lab or imaging results, Swanson pointed out. In some cases, the patient might access these records before getting a chance to talk them over with their doctor, which could cause unnecessary distress and break down trust.
“We don’t want to not be transparent. We want to give people their information, but they need to be given it with care, empathy and a knowledgeable voiceover so they understand the results that they’re getting,” Swanson stated.
Support for cultural and linguistic diversity is also crucial, he said.
Cultural awareness training alone isn’t enough, Swanson warned. Providers need practical resources — such as bedside translation services and visual reminders posted in rooms — to help them communicate sensitively with diverse patient populations, especially during busy clinical days, he explained.
How healthcare leaders can better understand the erosion of trust
It’s difficult to improve patient trust without reliable ways to measure it, said Mark Lomax, CEO of healthcare software startup PEP Health. Measurement enables providers to pinpoint when and where trust erodes so that they can then take immediate steps to rebuild it, he remarked.
Last week, PEP launched its “trust score” — a real-time metric that quantifies trust by using AI to analyze patient feedback all across the internet. The tool analyzes 40 million unsolicited patient comments from sources like social media, online reviews and patient forums — representing about 1 in 9 Americans, Lomax stated.
Unlike traditional surveys, which can be slow and usually have low response rates, the trust score taps into real, unfiltered patient feedback, he noted.
The startup based the score on academic research, especially the “RISE” model of trust, which includes logic, authenticity and emotional connection as its core pillars. Lomax said trust disappears if any one of these elements breaks down.
PEP’s goal was to codify trust using these concepts with natural language processing AI.
The company’s AI analyzes trust drivers and indicators, Lomax noted. Drivers are specific qualities that patients mention about their providers in their feedback, such as kindness or active listening. Indicators are observable patient behaviors that happen as a result of trust, such as patient retention or gratitude. Patients can reveal these kinds of behaviors by writing these like “I’ve been seeing Dr. X for five years” or “I’m so glad Dr. X took time to answer all my questions,” Lomax explained.
All of these factors are mapped out on a dashboard, forming a “real-time, 3D picture of trust,” he stated.
PEP’s trust score dashboard — which can be used by both providers and payers — analyzes trust across health systems, service lines, geographic regions and time. Scores are on a 1–5 scale, with 3 as a neutral point. A score below 3 means more negative than positive sentiment.
PEP’s internal analysis determined that a one-point decline in trust can result in more than $12 million in annual lost revenue for a large health system.
A study by Deloitte also found that providers with higher patient-reported experience scores performed better financially than those with lower scores. Specifically, hospitals that patients rated as “excellent” had an average net margin of 4.7%, compared to 1.8% for hospitals with low ratings.
Lomax pointed out that PEP’s tool is customizable. Users can tailor their dashboards to view data by geography, benchmark against their peers or analyze trust in specific clinical areas.
For example, ECU Health in North Carolina worked with PEP to develop a trust dashboard by market area, driven by interest from Julie Kennedy Oehlert, the health system’s chief experience officer. ECU is one of a few U.S. health systems that are piloting the trust score, Lomax said.
“Trust is the foundation of the relationship between healthcare and those they serve. When trust is present in the relationship, patients adhere to treatment plans, seek medical care when needed, and have frank conversations with their care team which is vital to their health planning,” Oehlert said in a statement. “This trust also fuels the passion and purpose of those that provide care, insulating against burnout.”
She also noted that the trust score is less about adding another metric for providers to manage and more about achieving a deeper understanding of patient relationships, which play an important role in overall health outcomes.
How more effective communication can help boost trust
Effective communication is a key piece of the puzzle for providers and payers looking to improve patient and member trust levels, noted Bob Farrell, CEO of healthcare engagement platform mPulse.
“We’re seeing progressive organizations do a better job at either repairing trust or building new trust by using digital engagement techniques to provide literacy, tailored touch points and specifics along a patient’s healthcare journey to help them feel like the plan or the provider understands what they’re going through,” he declared.
Americans increasingly want to be active participants in their healthcare, Farrell pointed out. They have more tools and information at their disposal than ever before — but it usually comes from sources like social media and ChatGPT, not their health plan or provider.
Farrell noted that healthcare organizations have the opportunity to use data analytics and AI to determine how best to engage with specific patients or members based on their health and demographic profiles.
“If you’re a 72 year-old male who has diabetes and has had two falls in the last 24 months, you’re going to have a much different profile than a 32 year-old woman who is dealing with prenatal and early childhood issues. You got to engage with those people correctly,” he remarked.
Personalization helps build trust because it helps people feel more understood, Farrell said. When payers or providers apply the same approach to very different populations, it can feel abrasive and impersonal, he explained.
When outreach is personalized, engagement rates significantly improve, sometimes jumping from the low single digits to the 20–30% range, Farrell stated.
He also highlighted the importance of delivering content that mirrors the user’s everyday digital experiences, such as Instagram-style video delivery, saying that this can improve receptiveness.
To rebuild trust, healthcare leaders need to recognize that patients don’t just want lab results and factual answers — they want to feel seen, heard and supported during some of life’s most difficult moments. Experts agree that in order to make patients feel this way, providers and payers need to employ a human approach centered on empathy and tailored communication.
Photo: porcorex, Getty Images
