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Aging, social capital, and health care utilization in Canada


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.

How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it. … That we often derive sorrow from the sorrow of others, is a matter of fact too obvious to require any instances to prove it; for this sentiment, like all other original passions of human nature, is by no means confined to the virtuous and humane, though they perhaps may feel it with the most exquisite sensibility. The greatest ruffian, the most hardened violator of the laws of society, is not altogether without it.

Adam Smith, The Theory of Moral Sentiments, Chapter 1, Part first.

Corresponding author
*Correspondence to: Dr Audrey Laporte, Associate Professor of Health Economics, Department of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5S 3M6, Canada. E-mail:
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Abbott, P. and Sapsford, R. (2005), ‘Living on the Margins: Older People, Place and Social Exclusion’, Policy Studies, 26(1): 2946.
Ai, C. and Norton, E.C. (2003), ‘Interaction Terms in Logit and Probit Models’, Economics Letters, 80: 123129.
Aizer, A. and Currie, J. (2004), ‘Competition in Imperfect Markets: Does it Help California's Medicaid Mothers?’, NBER working paper.
Barefoot, J.C., Maynard, K.E.Beckam, J.C.Brummett, B.H.Hooker, K. and Siegler, I.C. (1998), ‘Trust, Health, and Longevity’, Journal of Behavioral Medicine, 21(6):517526.
Berkman, L.F. and Glass, T.A.(2000), ‘Social Integration, Social Networks, Social Support, and Health’, in Berkman and Kawachi (eds), Social Epidemioology, New York: Oxford University Press.
Berkman, L.F., Glass, T.Brissette, I. and Seeman, T.E.(2000), ‘From Social Integration to Health: Durkheim in the New Millennium’, Social Science and Medicine, 51: 843–57.
Brown, T. et al. . (2006), ‘The Empirical Relationship between Community Social Capital and the Demand for Cigarettes’, Health Economics, 15(11):11591172.
Deri, C. (2005), ‘Social Networks and Health Service Utilization’, Journal of Health Economics, 24: 10761107.
Folland, S. (2006), ‘Value of Life and Behavior Toward Health Risks: An Interpretation of Social Capital’, Health Economics, 15: 159171.
Glendinning, C., Davies, B.Pickard, L. and Comas-Herrera, A. (2004), Funding Long-Term Care for Older People: Lessons from Other Countries, York: Joseph Rowntree Foundation.
Greene, W. (2003), Econometric Analysis, Upper saddle River, NJ: Prentice Hall.
Grossman, M.(1972), ‘On the Concept of Health Capital and the Demand for Health’, Journal of Political Economy, 80:223255.
Hawe, P. and Schiell, A.(2000), ‘Social Capital and Health Promotion: A Review’, Social Science and Medicine, 51: 871885.
Hendryx, M.S. et al. (2002), ‘Access to Health Care and Community Social Capital’, Health Services Research, 37:87103
Hyyppä, M. and Mäki, J. (2001), Why do Swedish-Speaking Finns Have Longer Active Life? An Area for Social Capital Research’, Health Promotion International, 16(1): 5564
Kawachi, I., Kennedy, B.P.Lochner, K. and Prothrow-Stith, D. (1997), ‘Social Capital, Income Inequality, and Mortality’, American Journal of Public Health, 87: 1491–98.
Kawachi, I., Kennedy, B.P. and Glass, R.(1999), ‘Social Capital and Self-Rated Health: A Contextual Analysis’, American Journal of Public Health, 89:11871193.
Lomas, J. (1998), Social Capital and Health: Implications for Public Health and Epidemiology’, Social Science and Medicine, 47:11811188.
Machado, J.A.F. and Santos Silva, J.M.C. (2002), ‘Quantiles for Counts’, CENMAP working paper CWP22/02.
Macinko, J. and Starfield, B. (2001), ‘The Utility of Social Capital in Research on Health Determinants’, The Milbank Quarterly, 79: 387427.
Marziali, E. and Donahue, P. (2001), ‘Resilience Indicators of Post Retirement Well-Being’, McMaster University, Social and Economic Dimensions of an Aging Population Research Papers, 43 pages.
National Physician Database (NPDB) (2001), ‘Figures used refer to Office and Unspecified (Major Assessments), Office and Unspecified (Other Assessments), Special Calls and Psychotherapy/Counselling’, Canadian Institutes for Health Information (CIHI).
Petris Center on Health Care Markets and Consumer Welfare (2004), ‘Special Interest Project 7-02: Social Capital and Cardiovascular Health in California’, Project Final Report, [15 January 2007].
Poortinga, W. (2006), ‘Social Capital: An Individual or Collective Resource for Health?’, Social Science and Medicine, 62:292302.
Portes, A. (1998), ‘Social Capital: Its Origins and Applications in Modern Sociology’, Annual Review of Sociology, 24(1):124.
Putnam, R.D. (2001), ‘Social Capital Measurement and Consequences’, ISUMA: Canadian Journal of Policy Research, 2(1):4151.
Rose, R. (2000), ‘How Much Does Social Capital Add to Individual Health? A Survey Study of Russians’, Social Science and Medicine,51(9):1421–35
Scheffler, R. and Brown, T. T. (2008), ‘Introduction: Special Issue on Social Capital’, Health Economics Policy and Law, 3: 321331.
Statistics Canada (1971–2006), ‘Censuses’, Statistics Canada catalogue nos. 97-553-XCB2006018, 91-213-X, 97-554-XCB2006007.
Sturm, R. (2002), ‘The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs’, Health Affairs, 21: 245252.
Subramanian, S., Kim, D. and Kawachi, I. (2002), ‘Social Trust and Self-Rated Health in US Communities: A Multilevel Analysis’, Journal of Urban Health, 79(S1): S21S34.
van Doorslaer, E. et al. (2004), Income-Related Inequality in the Use of Medical Care in 21 OECD Countries, Paris: OECD.
Veenstra, G. (2000), ‘Social Capital, SES and Health: An Individual-Level Analysis’, Social Science and Medicine, 50:619629.
Veenstra, G, et al. (2005), ‘Who You Know, Where You Live: Social Capital, Neighbourhood and Health’, Social Science and Medicine, 60: 27992818.
Winkelmann, R. (2006), ‘Reforming Health Care: Evidence from Quantile Regressions for Counts’, Journal of Health Economics,25(1):131145.
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Health Economics, Policy and Law
  • ISSN: 1744-1331
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