Journal article
Does social capital increase healthcare financing's projection? Results from the rural household of Uttar Pradesh, India
SSM - population health, Vol.15, pp.100901-100901
09/2021
DOI: 10.1016/j.ssmph.2021.100901
PMCID: PMC8383105
PMID: 34466652
Abstract
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.
•Social support assists household head to acquire external financing for healthcare payment.•But higher social support may not secure higher intensity of receiving external financing.•However, trust is a catalyst to acquire more financing conditional of any external financing was acquire in the first place.•Living in a cohesive community may restrict access to external financial resources.
Details
- Title: Subtitle
- Does social capital increase healthcare financing's projection? Results from the rural household of Uttar Pradesh, India
- Creators
- Md Zabir Hasan - School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, CanadaWilliam T Story - Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USADavid M Bishai - Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAkshay Ahuja - HCL Foundation, New Delhi, IndiaKrishna D Rao - Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAShivam Gupta - Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Resource Type
- Journal article
- Publication Details
- SSM - population health, Vol.15, pp.100901-100901
- DOI
- 10.1016/j.ssmph.2021.100901
- PMID
- 34466652
- PMCID
- PMC8383105
- NLM abbreviation
- SSM Popul Health
- ISSN
- 2352-8273
- eISSN
- 2352-8273
- Publisher
- Elsevier Ltd
- Language
- English
- Date published
- 09/2021
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984215016902771
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