Does social capital increase healthcare financing's projection? Results from the rural household of Uttar Pradesh, India.
India
Out-of-pocket health expenditure
SASCAT-I
coping strategies
mixed-effect model
social capital
Journal
SSM - population health
ISSN: 2352-8273
Titre abrégé: SSM Popul Health
Pays: England
ID NLM: 101678841
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
26
05
2021
revised:
23
07
2021
accepted:
19
08
2021
entrez:
1
9
2021
pubmed:
2
9
2021
medline:
2
9
2021
Statut:
epublish
Résumé
In the absence of adequate social security, out-of-pocket health expenditure compels households to adopt coping strategies, such as utilizing savings, selling assets, or acquiring external financial support (EFS) by borrowing with interest. Households' probability of acquiring EFS and its amount (intensity) depends on its social capital - the nature of social relationships and resources embedded within social networks. This study examines the effect of social capital on the probability and intensity of EFS during health events in Uttar Pradesh (UP), India. The analysis used data from a cross-sectional survey of 6218 households, reporting 3066 healthcare events, from two districts of UP. Household heads (HH) reported demographic, socioeconomic, and health-related information, including EFS, for each household member. Self-reported data from Shortened and Adapted Social Capital Assessment Tool in India (SASCAT-I) was used to generate four unique social capital measures (organizational participation, social support, trust, and social cohesion) at HH and community-level, using multilevel confirmatory factor analysis. After descriptive analysis, two-part mixed-effect models were implemented to estimate the probability and intensity of EFS as a function of social capital measures, where multilevel mixed-effects probit regression was used as the first-part and multilevel mixed-effects linear model with log link and gamma distribution as the second-part. Controlling for all covariates, the probability of acquiring EFS significantly increased (p = 0.04) with higher social support of the HH and significantly decreased (p = 0.02) with higher community social cohesion. Conditional to receiving any EFS, higher social trust of the HH resulted in higher intensity of EFS (p = 0.09). Social support and trust may enable households to cope up with financial stress. However, controlling for the other dimensions of social capital, high cohesiveness with the community might restrict a household's access to external resources demonstrating the unintended effect of social capital exerted by formal or informal social control.
Identifiants
pubmed: 34466652
doi: 10.1016/j.ssmph.2021.100901
pii: S2352-8273(21)00176-2
pmc: PMC8383105
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100901Informations de copyright
© 2021 Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
None.
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