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Analysis | Who trusts the healthcare system in Georgia?

27 April 2020
An amublance in front of a hospital in Tbilisi. Photo: Tamuna Chkareuli/OC Media.
As health officials in Georgia express concern about people not following their instructions, research carried out by CRRC Georgia examined who trusted Georgia’s healthcare system, and to what extent, may provide some clarity to what is going on.

Trust in healthcare institutions is important, especially during a pandemic like the current COVID-19 outbreak. In the name of public health, numerous individual freedoms and economic activities are restricted. 

Without trust in the messages of public health officials, measures aimed at preventing the spread of the virus are less likely to be complied with, exacerbating the spread of the virus. 

The recent events surrounding attendance at religious ceremonies and healthcare highlights the importance of trust in health institutions. The tensions between the church and healthcare professionals, including a public verbal clash between a high ranking church official and the National Center for Disease Control and Public Health, show this. 

Indeed, despite recommendations from healthcare specialists to stay home, the Orthodox Church in Georgia still held Easter liturgy with parishioners in attendance.

This situation leads to the questions: who is more or less likely to trust healthcare officials in Georgia and does this trust interact with religious belief? 

The 2019 Caucasus Barometer Survey provides some answers to these questions. The data was collected in mid-autumn 2019, before the current crisis. This has both advantages and disadvantages. 

On the one hand, attitudes could not have been influenced by the current crisis. Therefore, the responses allow an understanding of who would be more or less predisposed to trusting healthcare institutions before the crisis and therefore who would be more or less likely to comply with healthcare institution mandates. 

On the other hand, the data do not enable an understanding of how trust has changed in response to the current crisis.

At the time of the 2019 Caucasus Barometer survey, the plurality (43%) of Georgians trusted the country’s healthcare system. This is a relatively high level of trust compared to other institutions. 

Out of 15 social and political institutions, the healthcare system was the fourth most trusted institution. 

Further analysis using demographic variables, including settlement type, age, gender, employment, internet usage, minority status, and education suggests that males, those living in rural areas, ethnic minorities, and those that do not use the internet have higher chances of trusting the healthcare system, controlling for other factors. Other demographic factors do not show statistically significant differences.

Note: The original healthcare trust questions was asked using a 5-point scale. For the purpose of analysis, the options ‘fully trust’ and ‘rather trust’ were coded as ‘trust’ and options ‘fully distrust’ and ‘rather distrust’ were coded as ‘distrust’. The variables about ethnicity and Internet usage were also recoded. The minority status variable codes the following ethnicities as non-Georgian: Armenian, Azerbaijani, Russian, Kurd or Yezidi, other Caucasian, and other ethnicities. In the internet usage variable, options ‘at least once a week’, ‘at least once a month’, and ‘less often’ were coded as ‘less often’; ‘never’ and ‘do not know what the internet is’ were coded as ‘never’. 

Importantly, three of the above characteristics are interconnected, as minorities mostly dwell in rural areas of Georgia, and internet usage is least common in rural areas and among ethnic minorities

Indeed, the higher levels of trust among these groups could be because minorities and rural people are more likely to trust public institutions generally. 

Given the situation surrounding public health officials and the church, it is important to understand whether there are interactions between trust in religious institutions and healthcare officials. 

Indeed, the Caucasus Barometer data suggest trust toward religious institutions is associated with trust in the healthcare system. However, the observed relation tells us more about the phenomenon of general institutional trust. The results are similar when the relation between trust in the healthcare system and trust toward other institutions, like the army, police, banking system, or media are examined.

A second way of looking at it, that does not suffer from trust in one thing being correlated with trust in another, is through looking at the association between frequency of attending religious ceremonies and trust in healthcare institutions. 

Caucasus Barometer 2019 data suggest no statistically significant association between trust in the healthcare system and how frequently people attend religious ceremonies, controlling for other demographic factors. 

Based on this, the church-going population appears to have been no more or less likely to trust healthcare officials before the COVID-19 crisis.

Prior to the COVID-19 crisis, trust toward the healthcare system was associated with where people live, ethnicity, sex, and internet usage. Religiosity did not appear to be related to trust in the healthcare system before COVID-19. Whether these factors still hold true remains to be seen.

To explore the Caucasus Barometer 2019 survey findings for Georgia, visit CRRC’s Online Data Analysis portal. Replication code for the data analysis is available at CRRC’s GitHub repository here. 

Rati Shubladze is a policy analyst at CRRC Georgia. The views presented in this article do not represent the views of CRRC Georgia or any related entity.

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