Good health care starts with trust.
For 30 years, the California Health Care Foundation has worked to ensure all Californians can get the care they need. Across three decades of expanding coverage, supporting safety-net providers, and driving innovation, we have learned a singular truth: The health care system is only effective when it is built on a foundation of trust.
Without trust, patients don’t seek care when they need it. Communities remain isolated from life-saving resources. Systems stay siloed, and progress stagnates.
To mark our 30th anniversary, the foundation commissioned a statewide poll fielded by NORC at the University of Chicago to understand where trust stands today — who holds it, who is working to rebuild it, and what it will take to strengthen it across California. The findings are sobering, but they point toward a path forward.
It’s important to note that trust is shaped by forces beyond the health care system — forces our poll did not directly measure. For many immigrant families and mixed-status households, decisions about whether to enroll in coverage, fill a prescription, or take a child to a clinic are now weighed against fears of family separation driven by federal immigration enforcement. That is a profound barrier to care, and a form of distrust we cannot overlook.
Still, the poll’s findings about the system itself are revealing. Across Californians of every income level, region, race, and political affiliation, a clear picture emerges: While trust in the health care system is fragile, the path to rebuilding it is within reach. Here are key takeaways from the research.
Nearly Half of Californians Lack Trust in the System
Forty-six percent of Californians say they have little or no trust in the overall health care system. That number alone should give pause to every health care leader in the state. When we look closer, the picture grows more complex and more instructive.
Californians Trust the People Who Care for Them
One of the most striking findings is the wide gap between how Californians feel about individual caregivers and how they feel about institutions. Ninety percent say they trust nurses, and 84% trust their personal doctor. Trust drops sharply when the question turns to hospital administrators (49%), health insurance companies (33%), and pharmaceutical companies (30%).
This tells us that he relationships at the front lines of care are largely working and that the breakdowns are rooted in how care is organized, paid for, and delivered.
Cost and Continuity Shape Trust in Powerful Ways
Californians who have struggled with medical debt, skipped care because of cost, or lack a regular source of care report much lower trust in the system. This shows how trust is not just a matter of belief, it is a product of experience. When the system is unaffordable or unreliable, trust erodes.
Misinformation Is a Top-of-Mind Concern — and AI Is Raising the Stakes
Californians are paying close attention to the rise of health misinformation, and they are concerned. Seventy-three percent say it’s a major problem. When asked about artificial intelligence, 42% believe AI will increase false health information, compared with just 20% who think it will reduce misinformation. Only one in three Californians say they trust AI tools to provide reliable health information.
So this is a call to action for health care leaders. As AI accelerates, we have a narrow window to shape how it is deployed. Together, we have a responsibility to ensure it strengthens human connection in care rather than replacing it, and to ensure it becomes a tool for accurate information rather than a vector for harm.
Californians Know What Would Build Their Trust
The most hopeful finding in the poll is that Californians are clear about what helps shape their trust. Eighty percent say health care information that is easy to understand would have a positive impact on their trust. Seventy-nine percent say feeling seen, heard, and respected by their providers matters. Other things that rank near the top: Knowing costs up front, shorter wait times, and care that is easier to navigate.
They want information that’s intelligible. They want to feel seen and heard. They want care that is more affordable and easier to access.
The Work Starts Now
None of this is mysterious. None of it is out of reach.
For some Californians, this is about rebuilding trust that has been lost. For others who have never trusted the system, it’s about building trust for the first time.
Either way, the work starts now. The California Health Care Foundation is using this 30th anniversary to reflect on what trust will require of all of us — health care leaders, providers, policymakers, and advocates — in the decade ahead.
We invite you to read the full poll findings, consider what they reveal, and join us in the work of building a health care system Californians can believe in.
Read the full poll results.
