Access to health care and community social capital.
OBJECTIVE
To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community.


METHODS
The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources.


METHODS
The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables.


METHODS
Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling.


RESULTS
Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access.


CONCLUSIONS
The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.
Hendryx
Michael S
MS
Washington Institute for Mental Illness Research and Training, Washington State University, Spokane 99203, USA.
Ahern
Melissa M
MM
Lovrich
Nicholas P
NP
McCurdy
Arthur H
AH
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D018672:Community Health Planning; D003256:Community Participation; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D008297:Male; D008511:Medicine; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012650:Self Disclosure; D013038:Specialization; D014481:United States