We often hear that Americans have lost trust in healthcare.

A national survey released in August by the Annenberg Public Policy Center at the University of Pennsylvania, based on interviews with more than 1,900 American adults, found that 87 percent still have confidence in their own physician, nurse, nurse practitioner, physician assistant or other healthcare provider. That is statistically unchanged from two years ago.

In contrast, confidence in the CDC, FDA and NIH has fallen from between 72 and 74 percent two years ago to between 59 and 61 percent today—a decline of 11 to 14 percentage points.

The Annenberg survey measured confidence in federal health agencies, not hospitals. But a separate 2026 NORC survey of Californians found the same divide: 90 percent trusted nurses and 84 percent trusted their personal doctors, compared with only 49 percent who trusted hospital administrators, 33 percent who trusted insurance companies and 30 percent who trusted pharmaceutical companies.

Different survey, same message: People place far more trust in their caregivers than in the institutions managing and financing their care.

The most revealing part is not simply that institutional trust is lower. Confidence in personal caregivers has remained remarkably stable, while confidence in federal health agencies has declined and confidence in institutions managing healthcare remains substantially lower.

Americans have not rejected healthcare equally. They are distinguishing between the person they know and the institution they do not.

COVID undoubtedly contributed to that divide. Recommendations changed, experts sometimes contradicted one another, and politics became entangled with medicine in ways I had never witnessed during my healthcare career.

But we are now several years removed from the height of the pandemic, and the divide remains.

Perhaps COVID did not create the distrust as much as expose and accelerate it. People learned that institutions can be uncertain, political and occasionally wrong. They also learned that decisions affecting their lives were often made by people they would never meet.

Yet they continued trusting the caregiver sitting across from them.

That makes sense to me.

Institutions communicate through press releases, policies and carefully prepared statements. Caregivers communicate face-to-face.

An institution talks about populations. A caregiver talks to a person.

I have seen healthcare from the back of an ambulance, at the hospital bedside, inside administrative conference rooms and in boardrooms. Those experiences taught me that trust does not automatically flow from an organization to the people it serves.

It is earned personally.

Patients trust the physician who has cared for their family for years. They trust the nurse who notices they are frightened, the physician assistants and nurse practitioners who answer their questions, and the paramedic who explains what is happening during the worst ride of their life.

They may trust those people without trusting the hospital, corporation or government agency whose name appears on the building or paycheck.

That distinction may become increasingly important as healthcare grows larger and more consolidated.

The independent physician and independent community hospital are becoming rare. Nearly 70 percent of hospitals are now affiliated with larger systems, and more than four out of five physicians are employed by hospitals or other corporate entities.

There are understandable reasons for that. Large systems have the resources to purchase technology, recruit specialists, negotiate contracts and support hospitals that might not survive alone.

I have run hospitals in financial trouble. I understand that good intentions do not meet payroll.

Still, I wonder what consolidation does to trust.

Chattanooga reflects the national trend. Parkridge is part of Nashville-based HCA Healthcare. Memorial is part of Chicago-based CommonSpirit Health. Erlanger has announced a proposed partnership with South Carolina-based Prisma Health.

That does not mean those systems are untrustworthy. Size can provide resources and capabilities a local hospital could never afford independently.

But size can also create distance.

Patients may recognize the hospital’s name while having no idea who owns it, who governs it or where important decisions are made. Those questions matter. The larger healthcare organizations become, the harder it may be for people to feel that anyone is personally accountable to their community.

Deep pockets can purchase buildings, technology and physician practices.

They cannot purchase trust.

That raises an important question for healthcare leaders: Are institutions earning the public’s confidence, or are they borrowing it from the caregivers who work for them?

There is a difference.

Do patients trust a hospital because it provides excellent caregivers, or do they trust excellent caregivers and, by extension, the hospital where those caregivers practice? If it’s the latter, that is borrowed trust.

A hospital may benefit from the trust patients place in their physicians and nurses. But that trust does not automatically belong to the hospital. It was earned one conversation, one diagnosis and one act of compassion at a time.

Institutions should be careful not to mistake borrowed trust for institutional trust.

They can earn more of their own by communicating honestly, admitting uncertainty, explaining who makes decisions and remaining visibly accountable to the communities they serve. They should resist the temptation to hide behind carefully worded statements or send caregivers out to defend corporate decisions those caregivers did not make.

The surveys actually contain some good news.

Despite the anger, confusion and political division surrounding healthcare, most Americans still believe the person caring for them is trying to tell them the truth.

That relationship has survived.

The challenge for government agencies and healthcare institutions is not to assume that trust automatically belongs to them.

It is to become worthy of sharing it.

Something to think about.

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