Mediating effects between social capital and health care utilization in Italy–a structural equation model analysis

Background: Social capital, in its broad definitions, has been linked to improved health outcomes, yet the scarce consistency of social capital measurements and its further effects on healthcare utilization remain less clear. Particularly in Italy, where regional disparities and an aging population challenge the healthcare system, understanding these dynamics is crucial. This study proposes two population-based indicators of social capital and investigates whether they influence health itself and healthcare utilization. Method: Italian population data from 2014 to 2023 was used to develop two social capital measurements: Social support and Social participation, applying Item Response Theory (IRT). Hence, we applied structural equation modeling (SEM) to explore the pathways between social capital, self-reported health status, and healthcare utilization. The analysis includes control variables for demographic and behavioral factors. Results: Our main findings contribute with the current literature by identifying that population-based measures for social support and social participation may be useful for empirical research, and both direct and indirect effects of social constructs were found significantly associated with health and health utilization outcomes. Both social participation and social support were found to exert significant positive effects on self-perceived health and health utilization. The model suggests that while better social connections contribute to improved health, such increased support and participation can also lead to increased healthcare-seeking behavior. Conclusion: Social capital plays a dual role in shaping both health outcomes and healthcare utilization in Italy. Our findings highlight the relevance of social resources as population-level determinants of health and access, suggesting that strengthening community networks and health literacy can reduce inequities and enhance the efficiency of healthcare systems.