title: Social capital and refraining from medical care among elderly people in Japan.
abstract: Refraining from required medical care can worsen health, particularly for the elderly, and increase public medical expenditure, which destabilizes the financial aspect of social security. Social capital, such as trust between residents and the norms of reciprocity in the community, is a possible measure to prevent refraining from medical care.
  
  
  
  We studied survey data collected in a small area in Japan that included a high response rate (91.6 %) to evaluate refraining from medical care. Self-reported refraining from required medical care from among 1016 elderly people, aged ≥60 (male = 490; female = 526), was used as a dependent variable. Social capital indicators were mean values of people's attitude toward the generalized trust and norms of reciprocity in each community. We estimated the association between community level social capital and individuals' probability of refraining from medical care while controlling individual factors such as age, education, and marital status.
  
  
  
  Logit estimation results showed that only generalized trust is associated with low probability of refraining from medical care among the elderly in small communities. The marginal effect for 0.1 increase in community level trust is 4 % decrease in the probability of refraining from medical care. In larger communities, generalized trust is not associated with the probability of refraining from medical care.
  
  
  
  This finding suggests that the generalized trust is effective in smaller communities as far as related to access to medical care. In small communities, policy to increase generalized trust to support medical care for elderly is recommended.
authors.affiliation: Faculty of Policy Studies, Nanzan University, 27 Seirei, Seto, Aichi, Japan. mizuochi@ps.nanzan-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mizuochi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012111:Residence Characteristics; D066270:Social Capital; D012944:Social Support; D011795:Surveys and Questionnaires; D035502:Trust
keywords: Community; Elderly; Japan; Reciprocity; Refraining from medical care; Social capital; Trust