Risk, Trust and Uncertainty within Two Health Care Systems: Italy and England.

The proposed paper reviews literature and data in Italy and England comparing the relative trust patients and citizens express and experience in their health professionals and systems. This will be discussed in relation to the changing context of risk and uncertainty for patients and their families within two national health systems in the broader context of Europe.

The paper will discuss the implications for trust in the health care systems and actors in light of the shift in emphasis to governance as and away, apparently, from governmentality. In short, rather than trusting health professionals and especially doctors, to autonomously deliver good quality and affordable care under the new governance regimes the work of these professionals now have to be quality assured, increasingly it seems by the implementation of clinical and health care pathways.

The authors will explore the implications of recent developments in the two countries drawing on the recent work of Zinn (2006) and in light of previous theories of Luhman, Möllering and others. The paper will attempt to unravel the complex relation between growing user involvement in health care and patient confidence and trust in its public sector provision.