Public trust has long been recognized as crucial to the effective functioning of health care systems. In contrast to the abundant research in developed countries, there is no previous empirical study on public trust in health care systems in China. Moreover, health care system is one of the most dissatisfied public services in China, and the disturbingly high incidence of violent attacks against physicians and hospitals is the core problem in the operation of China's health care system, as well as an important social public issue in China. In addition, although the mistrust of the health care system has been inferred as the main cause of China's violence against physicians, there is no empirical evidence to be supported. Therefore, the primary objective of this study is to examine the level and determinants of public trust in China's health care system through a national survey in 26 provincial areas of China. The results show that public trust in China's health care system was 25.2%. Moreover, public trust in China's health care system was much lower than the trust in local governments, trust in most people in the society, and also lower than that of most of the countries or regions surveyed. Furthermore, satisfaction with most recent treatment experience was the lowest among the 29 countries surveyed. The results from the ordinal logistic regression model showed that respondents who had more trust in the local governments, had more trust in most people in the society, and were more satisfied with their most recent health care system experience were significantly more likely to trust the country's health care system. Moreover, the respondents who reported a higher level of happiness, positive attitudes towards social equity, and a higher level of self-identified social class were significantly more likely to trust in China's health care system. Furthermore, trust in local governments and satisfaction with most recent treatment experiences were the major determinants of public trust in China's health care system. Moreover, respondents who were older, had a lower annual income, and a higher education level had a higher probability of trusting China's health care system. In addition, the demographic variables explained few of the total variance of public trust in the health care system. In conclusion, public trust in China's health care system is low. Furthermore, the current low level of public trust in the health care system would be even lower if public trust in China's government were not so high. Therefore, Chinese policymakers should prioritize improving the health care system. Compared with the other determinants of public trust, improving experiences with health care treatment experiences appears to be not only the most urgent but also the easiest and most effective measure to improve trust in China's health care system.