Impact of Social Capital on the Availability of Health Care Services.

Abstract

Children with special health care needs (CSHCN) and their families experience many structural, financial, psychosocial, and physical obstacles to accessing and fully utilizing a continuum of health care services, including a myriad of contextual barriers that are unique to their local communities. Social capital is one contextual barrier hypothesized in the literature to reduce access to health care services. To better understand the role of social capital in accessing health care services for this vulnerable population, a study was constructed using data from a large representative sample of CSHCNs. The analysis was conducted on data collected through the National Survey of Children's Health, a cross-sectional study of child health that includes information on physical and mental health; access to health care; and neighborhood, school, and social context. Logistic regression analyses were performed on a reduced, complete data set containing only CSHCN (n = 32,496) using 5 medical home variables and an investigator-constructed social capital composite score. Social capital was not found to be a complete mediator of individual medical home characteristics; however, each increase in the social capital scale reduced the odds of experiencing a delay in care of overall health care services by 12.5% (P = .006). The effects of social capital on the accessibility of health care services is significant and focusing on strengthening social capital within communities will improve overall health outcomes for this vulnerable group of children.