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In the absence of adequate social security, out-of-pocket health expenditure compels households to adopt coping strategies, such as utilizing savings, selling assets, or acquiring external financial support (EFS) by borrowing with interest. Households' probability of acquiring EFS and its amount (intensity) depends on its social capital - the nature of social relationships and resources embedded within social networks. This study examines the effect of social capital on the probability and intensity of EFS during health events in Uttar Pradesh (UP), India. The analysis used data from a cross-sectional survey of 6218 households, reporting 3066 healthcare events, from two districts of UP. Household heads (HH) reported demographic, socioeconomic, and health-related information, including EFS, for each household member. Self-reported data from Shortened and Adapted Social Capital Assessment Tool in India (SASCAT-I) was used to generate four unique social capital measures (organizational participation, social support, trust, and social cohesion) at HH and community-level, using multilevel confirmatory factor analysis. After descriptive analysis, two-part mixed-effect models were implemented to estimate the probability and intensity of EFS as a function of social capital measures, where multilevel mixed-effects probit regression was used as the first-part and multilevel mixed-effects linear model with log link and gamma distribution as the second-part. Controlling for all covariates, the probability of acquiring EFS significantly increased (p = 0.04) with higher social support of the HH and significantly decreased (p = 0.02) with higher community social cohesion. Conditional to receiving any EFS, higher social trust of the HH resulted in higher intensity of EFS (p = 0.09). Social support and trust may enable households to cope up with financial stress. However, controlling for the other dimensions of social capital, high cohesiveness with the community might restrict a household's access to external resources demonstrating the unintended effect of social capital exerted by formal or informal social control., Competing Interests: None., (© 2021 Published by Elsevier Ltd.)

Country context has been shown to influence the association between social capital and health; however, few studies have examined how the level of societal affluence affects the relationship between social capital and health. Drawing on the study of individual-level socioeconomic variation in the returns to social capital by Uphoff and colleagues (2013), we examine two possible explanations about the differential impact of social capital on health based on country-level socioeconomic variation. The buffer hypothesis posits that social capital will have a greater benefit for poorer (versus more affluent) nations, whereas the dependency hypothesis suggests that social capital will be more beneficial in more affluent (versus poorer) nations. Using Waves 5 and 6 of the World Values Survey, we employed multilevel ordered logistic regression to examine whether national wealth moderates the association between social capital-as measured by particularized and generalized trust-and self-rated health across 72 countries. We also assessed five potential explanations for the moderating role of economic context based on the buffer and dependency hypotheses: institutional effectiveness, economic inequality, coverage of health services, human capital, and access to clean water and sanitation services. In support of the dependency hypothesis, we found that both particularized and generalized trust were associated with self-rated health to a greater extent in more affluent countries than in poorer countries; however, none of the potential explanations that we tested accounted for this pattern. Further, we found that particularized trust was more strongly associated with self-rated health compared to generalized trust across all countries. Future research should focus on the mechanisms by which economic context modifies the relationship between social capital and self-rated health., Competing Interests: None., (© 2019 The Authors.)