Laporte Audrey, Nauenberg Eric, Shen Leilei
Department ofHealth Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Health Econ Policy Law. 2008 Oct;3(Pt 4):393-411. doi: 10.1017/S1744133108004568.
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.
本文探讨了老龄化、社会资本与医疗保健利用之间的关系。利用2001年加拿大社区健康调查和加拿大数据普查的横截面数据，针对家庭医生诊疗（就诊次数）和住院治疗（年度住院天数）估计了一个两部分模型，重点关注社区层面社会资本（CSC）和个人层面社会资本（ISC）的影响。还对家庭医生诊疗就诊次数进行了分位数回归分析。CSC采用基于宗教和社区组织就业水平的佩特里斯社会资本指数（PSCI）来衡量[北美行业分类系统813XX]，ISC则基于自我报告的与社区的联系程度。较高的CSC/较低的ISC与老年人中较低的家庭医生诊疗就诊倾向/较高的住院利用率相关。第二部分（强度模型）的结果表明，PSCI指数增加一个标准差（0.13%）会导致家庭医生诊疗就诊次数总体减少5%，在加拿大每年可抵消约2.25亿加元。ISC的影响较小；然而，在住院强度模型中，这两种衡量指标均不显著。ISC主要影响较低分位数，与家庭医生诊疗利用呈正相关，而CSC的影响在中间分位数最为强烈。每种形式的社会资本可能通过不同机制发挥作用：ISC可能通过改善就医便利性（如交通服务）起到促进作用，而CSC则有助于避免一些可能涉及对老年人最重要的咨询/护理服务的医生诊疗。本文讨论了这些结果的政策含义。
