Paper short abstract:

There is erosion of trust between healthcare providers and regulators in India. A variety of influences, including corporatization of care, regulatory failures, and wider social changes, shape these trust relations, and thereby shape providers’ practices and relations with their patients.

Paper long abstract:

Commentators suggest there is erosion of trust within the health system in India and that there are generally low levels of trust between private providers, public providers, health managers and policy makers. In this paper, the situation of the providers of modern medicine is examined through an exploratory study in an urban setting in western India. This involved an examination of the nature of trust relations and what influenced the shape of these relations. Data on trust relations was collected through face-to-face interviews and focus groups with key informants which included public and private providers, regulators, managers, complimentary medical practitioners and other societal actors including patients/citizens, politicians and the media (N=17). 'Cut practice' dominated informants narratives about trust relations but this was attributed to a small number of 'rotten apples' in the medical profession but was not perceived to influence clinician patient relations. However, there was a perception that trust had broken down between providers and regulators. A variety of influences were evident including high cost of care provision, corporatization of care provision, intense social scrutiny of professional practice, the legal and regulatory environment, and wider social changes may be shaping the context for trust relations within the health care profession, and thereby shaping providers' relations with their patients. The insights gained from this exploratory study can form the basis for action to improve the stewardship and governance of the health system in India.