Access to health care and community social capital

Health Services Research,  Feb, 2002  by Michael S. Hendryx,  Melissa M. Ahern,  Nicholas P. Lovrich,  Arthur H. McCurdy

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Finally, some findings among the individual-level variables may seem unexpected. Family income did not predict reported access problems, although relative family income did--the higher the relative income, the fewer access problems reported. Relative income may better capture community variability because the same income may enable either higher or lower standards of living depending on the community in question. Higher level of education predicted more reported access problems; after adjusting for income, health status, insurance, and other variables, persons with higher education may be more sensitive to and/or better able to articulate the access problems they experience.

There are a number of study limitations that require us to be cautious about our conclusions. Causal relationships between access and community variables cannot be definitively established because of the cross-sectional nature of the data. We cannot conclude definitively that a particular community-level phenomenon impacts individual behavior. The effects are limited to large urban areas and may not generalize to smaller cities, rural areas, or subareas such as urban cores. The measures of public health services and collaborations are only counts of these activities, unadjusted for population coverage or MSA size (although we did examine collaboration rates per capita and found no difference in results).

In conclusion, this study suggests social capital may play a role in improving access to health care, perhaps a more important role than at least some structural health care sector variables. Such results are consistent with the theoretical role of social capital in making more efficient use of existing community physical capital resources and in promoting community accountability mechanisms. Further research is needed to confirm the role of social capital and to investigate the mechanisms by which it may improve access to health care. If social capital does contribute to more effective community accountability, the question also arises as to whether, and how, to manipulate it to improve health care services.