Trust is Vital: Lessons from 30 Years of Building Trust

Good health care starts with trust.

In 2026, the California Health Care Foundation is celebrating its 30th anniversary. Across three decades of work to improve the health care system for all Californians, we have learned a singular, undeniable truth: the system only works when it is built on a foundation of trust.

But right now, trust is fragile. Almost half of Californians say they trust the health care system little or not at all — and the forces driving that erosion are real.

We are witnessing a general erosion of faith in public institutions and the rapid rise of misinformation and disinformation that endangers patients. The affordability crisis and structural inequities have left many feeling that the system is not designed for them. For our immigrant communities, the fear of exposure when seeking health care makes trust a matter of basic safety. And as we stand at the dawn of the AI revolution, we face profound new questions about how to leverage technology without losing human connection.

For some Californians, this is about rebuilding trust that has been lost. For others — those who have never had reason to trust the system in the first place — it is about building that trust for the first time.

To achieve this, we must focus on five key areas:

1. Make It Easy

Outdated policies, administrative bloat, and convoluted processes leave everyday consumers wondering who the system is really serving. The frustration shows up in familiar ways: waiting too long for care, receiving bills that are impossible to understand, repeating the same information to provider after provider.

Nearly 3 out of 4 Californians tell us that their trust in health care depends a lot on how easy it is to navigate the system — and that trust is hard to earn when the system makes everything harder than it needs to be. A simpler system — one that modernizes legacy processes, connects data across providers, and opens wider “front doors” for finding and booking care — is essential to a healthier California that works for everyone.

2. Make It Affordable

Today, 6 out of 10 Californians skip care because they can’t afford it. Many blame institutional and corporate greed, and that perception — whether or not it tells the whole story — erodes trust across the board, for those priced out and those who can still pay.

Bringing down costs and creating real accountability around what’s driving them isn’t just an economic imperative. It’s foundational to rebuilding trust in the system.

3. Make It Clear

How care is delivered and how coverage is determined are already too often hidden from the people most affected. Technology should change that, not deepen it. Every tool should be transparent, every algorithm accountable — and the line between human judgment and algorithmic decision-making must always be clear.

Building trust in this new era means ensuring technology answers to the people it serves, not the other way around.

4. Make It About People

Trust is about relationships. That’s why having a regular primary care provider is such a big predictor of whether Californians trust the health care system. When people have a consistent primary care home, they’re more likely to feel seen and heard and to receive care that is responsive to their needs.

Across California, successful medical home models have already shown what’s possible when care is designed around people, not just conditions. Now we must extend that vision — investing in models that stretch beyond the four walls of a clinic to reach people where they are, ensuring that every Californian can access care that is safe, reliable, and built around them.

5. Make It Reflect California

A trustworthy health care system looks like the community it serves — and when patients share the same background as their provider, research shows they experience better communication, stronger perceptions of care, and better health outcomes. Yet California’s health workforce still has significant representation gaps — Latinos/x, for example, are nearly 50% underrepresented relative to their share of the state’s population.

Closing that gap means investing in workforce pipelines and care models that are rooted in the communities they serve — so that more Californians can see themselves reflected in their care.

Join us this year in recommitting to building a trustworthy health care system in California.