Trust is often discussed in healthcare as though it were a communications challenge: explain more clearly, reassure more often, restore confidence. But the evidence in our 2026 Healthcare Trends report points to something more consequential and harder to address. Patients do not lose trust because they have failed to understand the system. They lose trust because too often the system fails them in ways that are tangible, repeated, and difficult to ignore.
The Core Issue
That distinction matters. If trust is treated as a messaging problem, the response will be more or different messaging. If low or diminished trust is understood as a result of experience – of access barriers, navigation burden, affordability gaps, and uneven care – then rebuilding trust requires structural change that will in turn improve people’s experiences of healthcare.
Trust is built or weakened through practical encounters with care, not through announcements alone.
The core issue is not that patients are unwilling to trust. It is that the system too often asks for trust while producing experiences that make trust feel irrational.
Patients are told to trust the system, yet many cannot get timely appointments. They are told the system is coordinated, yet they must contact multiple places and repeat their story. They are told care is universal, yet many face out-of-pocket costs or skip medications because of affordability. They are asked to be compliant and then sent home, with no clear idea of how to resolve uncertainties or troubleshoot problems. They are told the system is there for them, yet many delay care, give up, or resort to self-management and emergency departments.
The system earns trust when it feels available, navigable, fair, and humane. It loses trust when the burden of making care work is pushed onto patients themselves.
The fact that reassurance from within the system is not the best way to earn trust does not mean expertise matters less. In fact, clinicians remain the most trusted source of health information in our trust report. But expertise alone is no longer enough if the surrounding system experience feels fragmented or indifferent.
This nuance helps explain an apparent tension in our findings. Canadians still trust doctors, pharmacists, nurses, and their family doctor at very high levels – and yet confidence in the broader system is weak. In strategic terms, that is a warning sign: institutional trust is lagging behind interpersonal trust.
Why Does Trust Keep Breaking?
Access delays signal that care may not be there when needed.
60% of Canadians say the healthcare system is either “deteriorating” (37%) or “in crisis” (22%). A general sense of crisis likely helps to explain why 15% of Canadians report waiting until their condition got worse before seeking care, and 12% report avoiding seeking healthcare altogether.
Improved access is the most-cited route to rebuilding trust: 27% say that greater access and speed would increase their trust in health systems. That finding suggests trust is being judged in operational terms.
Navigation burden makes patients do the system’s work for it.
10% of Canadians contact more than one place to get help, and 10% have had to repeat their health history, leading to many feeling overwhelmed and stressed (17%).
Chasing multiple pathways, repeating medical history, and encountering dead ends tell people the system is not organized around their reality. The burden leads some to avoid care, exacerbating the toll on patients and the system.
Uneven experiences make trust feel like a privilege that doesn’t extend to all.
Lower-income and racialized Canadians are not encountering the same pathways or burdens as others: 23% of racialized Canadians used a walk-in clinic for care, versus 13% of White Canadians; and among those earning under $60,000, 10% reported a tendency to not take prescribed medication due to cost, compared with 4% among those earning $100,000.
When trust depends on income, geography, time, confidence, or social capital, the promise of a universal system becomes harder to believe.
The system often speaks in aggregate while patients experience it personally.
People differ in what they need from healthcare interactions: some want clarity and direction, some want autonomy, some need communications that reduce complexity, and some need approaches that feel emotionally relevant or holistic. A system that communicates and designs care as though trust means the same thing to all patients will keep missing the mark.
How Do We Rebuild Trust?
The findings support a more grounded answer than “communicate better.” Trust will be rebuilt when patients can feel, in concrete ways, that the system is more responsive than it was before. That means improving access, reducing friction, strengthening coordination, and making care pathways feel more predictable and fair. It also means designing communications and experiences that reflect different patient realities rather than assuming one approach will strike everyone as equally credible and reassuring.
The strategic opportunity here is not only to improve satisfaction. It is to reduce the conditions that push people toward avoidance, delay, self-management, and alternative information ecosystems.
A more patient-centric model means getting a more accurate picture of what different patients need to feel respected, informed, and supported. It means moving beyond assumptions. It means recognizing that trust is not restored by asking patients to believe in the system again. It is restored when the system gives them a reason to believe.
