Different Perceptions of Trust and Uncertainty in healthcare by Country:

Japan:
137854 417..429 (emerald.com)-(Japan is often understudied in this context because Japanese patients
and healthcare settings are usually reluctant to participating in research and answering questionnaires
related to healthcare).Paper on Japanese perceptions on their healthcare system. They seem to care for
both technical and functional attributes. Japanese healthcare system is seen as excellent at face value or
on the surface and people pay relatively cheap prices. However, recent research shows that poor
patient doctor interactions and relationships affect (negatively) the patient experience. It is a fee pay
system in which service prices are fixed by the government. Hence. Some argue that this standardizes
the field and does not allow for specialization and competitiveness to develop (development and
ingenuity). This is perhaps a clarion by these authors for the health system of Japan to be changed to a
market system like the USA. There is a lack of restriction on frequency and duration of visits, which leads
to high-volumes of visits with short turn arounds (consultation time). This, the authors claim, reduces
the quality of the visits so that doctors can maintain their high incomes. This type of healthcare system
reduces the wait time, but also the time spent interacting with the doctor. I fact, the doctors do not care
about how they see their patients or what they do to patients, they only care for consulting the
maximum amount of patient possible in a day. This has led to really poor bedside manners and the
consumers claim that these poor communications skills and affects their experience and evaluation of
their doctors. “Poor communication between patients, physicians and nurses in Japanese medical
settings appears to be a strong barrier to establishing deep and long-lasting relationships with
healthcare organizations. Medical practices and healthcare systems need revising before they can adapt
to Japanese society’s needs.” (p.420)-Findings: “Generally, our study demonstrates that Japanese
healthcare providers ought to take patient needs into account. Providers are encouraged to build long-
term relationships with patients if they want to maintain their viability. Evolution at the micro and
macro levels seems necessary to avoid an unsolvable “breakdown” of Japanese medical services”(page
426)

309019 692..705 (emerald.com)- Author starts with this sentences, which I think are extremely relevant
to our discussionand reflect what I had found oreviously: “Health care institutions need to go beyond a
medical view and embrace a holistic social approach to healthcare. Accurate diagnosis and treatment
are no longer enough; patients need performance in all services they receive (Angelopoulou et al., 1998).
Performance makes consumers return to the same provider and spread more favorable “word of mouth”
recommendations (Youssef, 1996). Consequently, in order to guide care providers toward better resource
allocation while maximizing their profits, researchers are trying to identify patients’ priorities and
preferences among various health care quality attributes across different countries, along different
medical settings and for different types of consumers. Healthcare is a high involvement service as it
concerns the person’s health and well being. Consumers are then more aware and motivated to process
the available information concerning the health care service. Moreover, human beings live as members
of groups that share common values and norms and interact according to specific rules and laws, which
shape several human reactions. Service satisfaction and dissatisfaction are kinds of human reactions
emanating from evaluation processing and are indeed subject to cultural and personal issues. Thus,
studies in contexts different from those mostly explored (American, European) are necessary to shed light
on local specificities and their potential effect on healthcare service perceptions” (page 683). This also
ties quite organically with knowledge ecologies. Moreover, the author also reiterates that the Japanese
system tends to over-regulate (however, she was a coauthor in the previous paper). The author claims
that patients’ rights are absent and that a submissive attitude prevails in the patient doctor relationship.
Hence, contrary to American ecology of knowledge, where patients are staring to challenge and contest
the paternalistic attitudes of some doctors and healthcare institutions, this is not yet the case in Japan.
Findings-“Japanese outpatients focus and care about delivery processes. This includes service speed,
quality of interaction with staff and the setting’s appearance. This is what determines their assessment
of healthcare service quality. Important insight: “In contrast with individualistic cultures (USA and
Europe), Japanese despise specific attention and individualized staff behaviors considering that
physicians or nurses should deal equally with all patients. They avoid judging staff skills and knowledge
as it is inappropriate to the high hierarchical level accorded to the medical profession. Patient
satisfaction is affected by process characteristics and satisfied patients are likely to return to the same
provider and recommend it to their families and friends. To satisfy health care service consumers,
providers should emphasize efficiency and courtesy, be responsive and willing to help, impart confidence
and trust. Satisfaction can be important for maintaining long-term relationships, having a significant
impact on the intention to return and willingness to recommend.” (page 701)

USA:

Germany:

France: