Coping with the costs of primary care? Household and locational variations in the survival strategies of the urban poor.

This paper examines the 'survival' strategies adopted by lower income groups seeking to cope with the costs of primary care. Two surveys, one of the health and health service concerns of clients of an inner city voluntary welfare agency, and another of how 114 general practitioner (GP) surgeries in Christchurch, New Zealand aided patients in financial distress, were conducted in October-December, 1997. Patients adopted a variety of strategies, both active and passive, with delays in obtaining medications and seeking financial help from GPs being the most common. Although less important, high rates of switching GPs occurred. There was evidence of geographical variation in the strategies adopted by patients and practices as well as of the effects of such strategies given that considerable levels of unmet need remain. I conclude that more attention should be paid to the gatekeeper role of GPs and how their actions in different social contexts may result in inequalities in service provision to low income patients and outcomes of care.