Faculty of Policy Studies, Nanzan University, 27 Seirei, Seto, Aichi, Japan.
BMC Health Serv Res. 2016 Aug 2;16:331. doi: 10.1186/s12913-016-1599-8.
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.
拒绝必要的医疗护理会导致健康状况恶化，尤其是老年人，同时也会增加公共医疗支出，从而破坏社会保障的财政稳定性。社会资本，如居民之间的信任和社区互惠规范，可能是预防拒绝医疗护理的一种措施。
我们研究了在日本一个小区域收集的调查数据，该区域的响应率很高（91.6%），用于评估拒绝医疗护理的情况。将 1016 名 60 岁及以上老年人（男性=490；女性=526）报告的拒绝必要医疗护理作为因变量。社会资本指标是社区内每个人对普遍信任和互惠规范的态度的平均值。我们在控制个体因素（如年龄、教育和婚姻状况）的同时，估计了社区层面的社会资本与个人拒绝医疗护理的概率之间的关系。
Logit 估计结果表明，只有普遍信任与小社区中老年人低概率拒绝医疗护理相关。社区层面信任增加 0.1，拒绝医疗护理的概率就会降低 4%。在较大的社区中，普遍信任与拒绝医疗护理的概率无关。
这一发现表明，普遍信任在与获得医疗护理相关方面在较小的社区中是有效的。在小社区中，建议采取增加普遍信任以支持老年人医疗护理的政策。
