Do bonding, bridging, and linking social capital affect preventable hospitalizations?

Community-level factors have been associated with access to health care, above and beyond covariates such as individual health status, insurance coverage, and sociodemographics. For example, previous research has found that neighborhood is related to whether individuals report a usual source of care, physician use, receiving preventive care, and having unmet need for care (Kirby and Kaneda 2005; Litaker, Koroukian, and Love 2005). Social capital has been suggested as a community-level characteristic and research exploring its link with health and health care has come “fast and furious” during the last decade (Veenstra 2002). The idea of social capital—defined generally as the institutions, relationships, and norms that shape the quality and quantity of a society's social interactions—has engendered much enthusiasm among public health researchers and policy makers. However, criticisms are increasing, in particular regarding the widely varying and ambiguous definitions of social capital and the lack of clarity regarding its causal mechanisms with health (Labonte 1999; Leeder and Dominello 1999; Lynch et al. 2000; Macinko and Starfield 2001). The overwhelming majority of empirical research on social capital has focused on health outcomes and much less on health care access and utilization. And the measures used to examine the relationship between social capital and access or utilization, as well as the findings and context, vary widely. Most studies have created one or more social capital scales by aggregating and combining a range of individual measures such as perceived interpersonal trust and social control/cohesion, community and voting participation, and sense of personal safety and efficacy (Hendryx et al. 2002; Greenberg and Rosenheck 2003; van der Linden et al. 2003; Wan and Lin 2003; Drukker et al. 2004; Lindstrom et al. 2006). Conceived of this way, social capital has been associated with individuals reporting fewer access problems across MSAs in the United States (Hendryx et al. 2002) and better access to a regular doctor in Scania, Sweden (Lindstrom et al. 2006); however, other studies found that the social capital scale was only related to access or utilization through its relationship to other factors like health status (Wan and Lin 2003) or neighborhood poverty (van der Linden et al. 2003; Drukker et al. 2004). When individual indicators of social capital (as opposed to a scale) have been used to examine health care access, the findings have also been largely inconclusive (Aye, Champagne, and Contandriopoulos 2002; Prentice 2006). Further, although community-level variables such as the number of nonprofit organizations or churches in a community have been identified as important types of social capital, these have not been examined in health studies. In addition to having widely varying measures of social capital, previous literature on social capital and health care has been limited because there have been very few conceptual frameworks proposed. Furthermore, theoretical distinctions have been made in the broader literature on social capital and health between bonding, bridging, and linking ties, but only one previous article has distinguished empirically between bonding and bridging (Kim, Subramanian, and Kawachi 2006), and none have examined linking social capital. The objective of this paper is to test an original conceptual framework for social capital and health care access and utilization by operationalizing bonding, bridging, and linking social capital and examining their relationships with a validated measure of community access (Bindman et al. 1995), preventable hospitalizations (PHs).