ObjectiveTo identify factors associated with health‐care system satisfaction in China.ContextRecent research suggests that socio‐demographic characteristics, self‐reported health, income and insurance, ideological beliefs, health‐care utilization, media use and perceptions of services may affect health‐care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health‐care system satisfaction.DesignStratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013.Main outcome measureSatisfaction with the way the health‐care system in China is run.ResultsWe find only weak associations between satisfaction and socio‐demographic characteristics, self‐reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health‐care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical.ConclusionsTo improve satisfaction, Chinese policymakers – and their counterparts in countries with similar health‐care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices.

How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence.

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The greater the gap between democratic ideals and reality, the greater the resulting tension. This chapter presents a model of tension in a new democracy and applies it to the Republic of Korea (South Korea), drawing on survey data from the 1997 New Korea Barometer. South Korea is particularly suitable for intensive analysis, since the level of mass education is high and commitment to democratic ideals is also high, yet the introduction of free elections in 1987 has produced a succession of presidents whose actions in government have fallen well short of the democratic ideal, leading to convictions on corruption charges. The political fallout of the abuse of power for personal gain was exacerbated in 1997 when the government faced the national humiliation of relying on the biggest International Monetary Fund loan in history to avoid financial collapse and the chapter concludes by considering demand‐driven pressure for reform.