Public satisfaction and trust towards the health system in China and associated factors: a mixed-methods study.

BACKGROUND: Public's perceptions of the health system provide valuable insights into its performance and inform future directions for improvement. This research aims to evaluate changes in public satisfaction and trust towards China's health system from 2011 to 2021 and to identify the key factors influencing these perceptions. METHODS: Using a mixed-methods design, this study examined changes in public satisfaction and trust in China's health system from 2011 to 2021 and explored the key factors associated with public satisfactionand trust. Quantitative data were drawn from the Health and Healthcare module of the Chinese General Social Survey, and qualitative in-depth interviews with 31 key informants were conducted to investigate these issues and uncover the underlying reasons for public satisfaction and trust in China's health system. RESULTS: Public satisfaction with China's health system increased from 60.58% in 2011 to 78.61% in 2021, and public trust increased from 48.43% to 71.46%. Factors such as age, education, and income significantly impacted public satisfaction and trust. Logistic regression results showed that trust in doctors and perception of healthcare accessibility were key factors influencing public satisfaction and trust in the health system. Negative healthcare experiences lowered satisfaction, partly by reshaping trust in doctors and perceptions of healthcare accessibility, though they did not significantly affect trust in the health system. Qualitative findings highlighted the importance of healthcare experiences and doctor-patient interactions in shaping satisfaction and trust, with poor interactions identified as a key factor in dissatisfaction. CONCLUSION: There were significant improvements in public satisfaction and trust towards the health system in China from 2011 to 2021. Perceptions of healthcare service performance, negative healthcare experiences, trust in doctors, and perceptions of healthcare accessibility are key factors influencing public satisfaction and trust. To further enhance public satisfaction and trust, continued reforms to the integrated delivery system are needed to reduce financial barriers, improve doctor-patient interactions, and strengthen communication with the broader public.