The present study aims to compare the valuation of public health care systems’ performance efficiency from stakeholders’ perspective categorized based on their income. Questionnaire data were analyzed using structural equation modeling. Data analysis indicated that stakeholders across both income groups positively associated health care quality, adequacy of facilities, and professional competency with the performance efficiency of public health care systems. In contrast, ‘trust’ demonstrated a negative association, which is a counterintuitive behavior, with perceived performance efficiency in both income groups. The observed negative association between trust and perceived system performance, particularly among high-income stakeholders, may be interpreted through the lens of cognitive dissonance, wherein expectations shaped by private-sector experiences conflict with perceptions of public health care delivery.