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Trust in many institutions, such as government and media, has declined in the past two decades. Although such trends are well documented, they are not well understood. The study described in this report presents a new framework for assessing institutional trust and understanding the individual characteristics and institutional attributes that affect trust. Analysis is based on a survey of 1,008 respondents conducted through the RAND Corporation's American Life Panel in April 2018. The study makes several key contributions to the field of institutional trust research. First, researchers used a scale that distinguishes between trust and distrust, thus allowing a different understanding of trust. Second, the analysis is a first step toward understanding why people trust institutions. The framework allows exploration of components of trustworthiness—i.e., the institutional attributes that people say they consider important to levels of trust (e.g., integrity, competence). The researchers also analyzed relationships between components of trustworthiness and the individual characteristics of those expressing the level of trust. Third, the survey featured questions about multiple institutions, allowing researchers to make comparisons across institutions. The research provides insights into individual characteristics and institutional attributes associated with institutional trust. This study is a "first cut" at a complicated concept and at exploring what is needed to rebuild institutional trust.

Trust --- Social aspects --- Political aspects --- Since 2017 --- United States --- United States. --- Politics and government

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There are approximately 2.8 million remaining uninsured individuals in California and they often have limited access to cost-effective preventive care and mental health services. To address this issue, California initiated the Global Payment Program (GPP), a pilot program included in the state's current Section 1115 demonstration waiver to support public health care system (PHCS) efforts to deliver more cost-effective and higher-value care to the state's uninsured. The GPP seeks to improve care to the uninsured by providing GPP funds that can be used to pay for a broad set of services, including non-traditional services and services provided in non-traditional settings. California developed a system of points to provide a value for each service and to track service use relative to each PHCS's budget. The goal is to provide a flexible payment system that encourages the delivery of high-value services, particularly those in lower-intensity care settings to address the needs of PHCS patients. This report documents findings of the final evaluation of the GPP. Through the GPP, PHCSs have put in place a variety of strategies and offered a wider range of services to improve care for the uninsured in California. Utilization of outpatient, non-emergency services increased over the three-year period, while emergency room services and inpatient days decreased. Non-traditional service utilization increased in different ways across PHCSs, indicating that the PHCSs were able to tailor their services to the needs of their patient populations.