Coping with the costs of primary care? Household and locational variationsin the survival strategies of the urban poor

This paper examines the 'survival' strategies adopted by lower income group s seeking to cope with the costs of primary care. Two surveys, one of the h ealth and health service concerns of clients of an inner city voluntary wel fare agency, and another of how 114 general practitioner (GP) surgeries in Christchurch, New Zealand aided patients in financial distress, were conduc ted in October-December, 1997. patients adopted a variety of strategies, bo th active and passive, with delays in obtaining medications and seeking fin ancial help from GPs bring the most common. Although less important, high r ates of switching GPs occurred. There was evidence of geographical variatio n in the strategies adopted by patients and practices as well as of the eff ects of such strategies given that considerable levels of unmet need remain . I conclude that more attention should be paid to the gatekeeper role of G Ps and how their actions in different social contexts may result in inequal ities in service provision to low income patients and outcomes of care. (C) 2001 Elsevier Science Ltd. All rights reserved.