Regulating Care: How Transparency, Ownership, Control, and Sanctions Shape Trust and Preferences

ABSTRACT Of the various attributes and regulatory tools related to nursing home service provision—such as ownership, transparency, oversight, and sanctions—which are seen as preferable and are most trusted? To address this question, we conducted a conjoint survey experiment on nursing home services with 1009 direct relatives of nursing home residents in Spain. Participants evaluated hypothetical nursing home profiles that varied across core service characteristics and regulatory tools: ownership, transparency, oversight body, and control and sanction mechanisms. The article shows that individuals prefer public and nonprofit providers, five‐star quality ratings, disclosure of inspection results, and strict sanctions. However, when examining which models are most trusted, our results indicate that trust is shaped by overlapping but distinct factors. As with preferences, respondents place greater trust in public and nonprofit providers, but trust is also shaped by participatory mechanisms, suggesting that opportunities for involvement and having one's voice heard have a core role in shaping confidence in care provision.