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May 31, 2026
Quarterly Article
Silvia Cannas
Maria Cucciniello
December 2023
Back to The Milbank Quarterly
Policy Points:
Context: Trust in the US health care system has declined substantially in recent years, threatening patient engagement, care outcomes, and health policy effectiveness. While prior research confirms that direct personal experiences with providers shape trust, questions remain about the influence of vicarious experiences—the health care stories shared by family members, friends, and community networks. This gap is particularly consequential in the United States, where structural inequalities have created distinct collective memories and expectations that circulate within racial and ethnic communities. This study addresses this gap by examining how the emotional valence (positive or negative) and racial identity of the narrators influence trust in the US health care system, with attention to variation by respondents’ race and baseline trust in their own provider.
Methods: We conducted a 2×2 between-subjects online survey experiment with 1,042 US adults. The sample was demographically representative by age, education, and gender, and evenly divided between non-Hispanic White and non-Hispanic Black participants. Respondents were randomly assigned to eight brief vignettes that varied in two dimensions: (1) emotional valence (predominantly positive vs. predominantly negative) and (2) narrators’ racial identity (majority in-group vs. majority out-group).
Findings: We find that vicarious experiences significantly affect trust in the US health care system—but not uniformly. Non-Hispanic White participants were not affected by in-group experiences and responded to out-group accounts, while the contrary held for non-Hispanic Blacks. Trust in one’s own doctor moderated these effects: strong patient–provider relationships buffered individuals from the impact of systemic stories, whereas low provider trust heightened susceptibility to narrative influence.
Conclusions: These findings underscore the role of collective narratives in shaping systemic trust and highlight new avenues for its strengthening among diverse populations.
