Research on the Effect of Community Variability on Financing Strategy Effectiveness
How does a community’s social capital, level of income inequality, and financing and organizational arrangements affect access to health care, satisfaction with care, out-of-pocket costs, and health status? To examine the role of these community characteristics researchers at Washington State University tested three hypotheses: 1) social capital and income inequality variables are more powerful predictors of health status, access to care, cost, and satisfaction with care than type of insurance coverage, physician supply, or managed care penetration; 2) for those with a given type of insurance status (including uninsured), community characteristics, including social capital explains significant variability in health status, access to care, costs, and satisfaction with care; and 3) social capital mediates the relationship between independent variables (income inequality, type of insurance coverage, physician supply, and managed care penetration) and dependent variables (access, satisfaction, cost, and health status). They merged the Community Tracking Study Household Survey with data from the U.S. Census, the National Media Marketing database of Social Capital Indicators, interviews with public health department officials in selected cities, the National Directory of Managed Care Organizations, local and state medical societies’ data on physician supply, and FBI Uniform Crime Reports. The objective of this study was to test the hypothesis that in communities with high social capital, the effects of income inequality, insurance coverage, and managed care penetration on dependent variables will be weak, while communities with low social capital will have relatively stronger relationships between the two sets of variables.