title: Aging, social capital, and health care utilization in Canada.
abstract: This paper examines relationships between aging, social capital, and healthcare utilization. Cross-sectional data from the 2001 Canadian Community Health Survey and the Canadian Census are used to estimate a two-part model for both GP physicians (visits) and hospitalization (annual nights) focusing on the impact of community- (CSC) and individual-level social capital (ISC). Quantile regressions were also performed for GP visits. CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and ISC is based on self-reported connectedness to community. A higher CSC/lower ISC is associated with a lower propensity for GP visits/higher propensity for hospital utilization among seniors. The part-two (intensity model) results indicated that a one standard deviation increase (0.13%) in the PSCI index leads to an overall 5% decrease in GP visits and an annual offset in Canada of approximately $225 M. The ISC impact was smaller; however, neither measure was significant in the hospital intensity models. ISC mainly impacted the lower quantiles in which there was a positive association with GP utilization, while the impact of CSC was strongest in the middle quantiles. Each form of social capital likely operates through a different mechanism: ISC perhaps serves an enabling role by improving access (e.g. transportation services), while CSC serves to obviate some physician visits that may involve counseling/caring services most important to seniors. Policy implications of these results are discussed herein.
authors.affiliation: Department ofHealth Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. audrey.laporte@utoronto.ca
authors.forename: Audrey
authors.initials: A
authors.lastname: Laporte
authors.forename: Eric
authors.initials: E
authors.lastname: Nauenberg
authors.forename: Leilei
authors.initials: L
authors.lastname: Shen
mesh_terms: D000328:Adult; D000375:Aging; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D012944:Social Support