Maintaining Policy Support for Contested Health Reforms: The Role of Trust, Emotion, and Procedural Legitimacy

Background Health reform often faces resistance from key stakeholders, thus making public support essential to achieving reform goals. In Korea, efforts to expand the medical workforce—and the resulting mass resignations—highlight this challenge. While previous studies examine public trust, how it interacts with perceptions and emotions in response to reform remains less clear. We investigate how trust, problem perception, and emotional responses shape policy support. Methods In December 2024, 1,000 Korean adults aged 19 and over were surveyed using quota sampling. The responses regarding policy support, government trust, and emotions regarding policy conflicts were included. Structural equation modeling tested a moderated mediation model. Findings perceived physician shortage (B = 0.016; 95% CI, 0.010–0.022) and support for expansion policy (indirect = 0.005; direct = 0.066) were positively associated with trust in government. The link between problem perception and policy support was strengthened and weakened by negative emotion (B = 0.225; 95% CI, 0.052–0.399) and procedural justice (B = -0.220; 95% CI, –0.348 to -0.092), respectively. Anger marginally moderated support for expansion (B = 0.203; p < .10), while disappointment significantly reduced support for reform (B = -0.231; p < .01). Interpretation Whether to support the government’s health reform policy depends on both the content and implementation. To achieve sustainability of the current system, health authorities should reinforce ways to make reform policies more inclusive and transparent as well as emotionally resonant.