Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan

• Published in: Social science & medicine (1982) Vol. 211; pp. 102 - 113
• Main Authors: Herberholz, Chantal, Phuntsho, Sonam
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2018; Pergamon Press Inc
• Subjects: Access; Bhutan; Cognitive social capital; Economic status; Geography; Health behavior; Health care; Health facilities; Health facility level; Health services utilization; Healthcare utilization; Help seeking behavior; Households; Individual social capital; Outpatient care facilities; Outpatient treatment; Output measure of social capital; Power; Primary care; Regression analysis; Residence; Rural and urban areas; Rural areas; Rural communities; Social capital; Standard of living; Structural social capital; Urban areas; Bhutan; Bhutan; Health facility level; Structural social capital; Output measure of social capital; Healthcare utilization; Individual social capital; Cognitive social capital; Rural and urban areas
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.06.010

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan. •Individual social capital increases the probability of outpatient care utilization.•Individual social capital affects the choice between different levels of health facilities.•The distinction between the components of individual social capital matters.•Stark differences exist between Bhutan's rural and urban areas.