Trust by design: the effects of personal interest vs. social responsibility frame on policy acceptance and patient trust in China's DRG reform.

backgroundDiagnosis Related Groups (DRG) payment reform has been widely adopted internationally to improve efficiency and contain healthcare costs. In recent years, China has accelerated the implementation of DRG and Diagnosis-Intervention Packet (DIP) payment systems, with more than 90% of pooled regions adopting these mechanisms by the end of 2023. While such reforms have standardized service delivery and reduced patient expenses, public awareness and understanding remain limited, raising concerns about their potential impact on patient trust. This study examines how personal interest versus social responsibility framing influences patients' trust in the healthcare system and the acceptance of DRG payment reform.

methodsA survey experiment was conducted among obstetric patients of different due dates (N = 229) in a region where DRG reforms have been implemented in China, assessing responses to 2 types of messages designed to increase awareness and acceptance of DRG policies. Independent-samples t-tests were used to compare groups of different frames. Mediation effects of patient trust and potential moderating effects of temporal distance were tested using a structural equation model, and regression models were employed to examine predictors of specific trust.

resultsCompared to the social responsibility frame, participants exposed to the personal interest frame reported higher levels of general patient trust, with the difference driven primarily by trust in the healthcare system rather than trust in the medical profession. Structural equation modeling indicated a significant indirect association between framing condition and policy acceptance through general patient trust. In addition, general patient trust was positively associated with specific trust. Temporal distance and its interaction with framing were not significantly associated with policy acceptance.

conclusionFraming policies in terms of personal benefits is more effective than emphasizing social responsibility in enhancing general patient trust. Even when such frames do not directly increase policy acceptance, general patient trust emerged as an important psychological pathway connecting message framing to reform evaluation. Against the backdrop of low public awareness of DRG reform, these findings underscore the importance of clearer and more accessible policy communication. CLINICAL TRIAL NUMBER: Not applicable.