Social inequality and general practitioner utilisation : assessing the effects of financial barriers on the use of care by low income groups

AIMS: To evaluate the extent to which financial barriers are still important deterrents to the utilisation of primary care by low income groups and to examine whether the willingness of patients to switch doctors is associated with ability to pay. METHOD: A practice and a population survey was used to compare the importance of price barriers, patient satisfaction and utilisation rates in two low income areas of Christchurch. Comparisons are made on the basis of gender, age, perceived health status, housing tenure, benefit status, income and ethnicity. RESULTS: Despite the introduction of the Community Services Card, delays in using services because of the cost of care remain significant for many groups of patients, including cardholders themselves. The removal of price barriers at the free clinic raised utilisation rates for all groups. Patterns of use at the free clinic show a consistent inverse relationship between income and consultation rates. However, this was not evident among patients in the population sample who continued to use fee-for-service providers. Further, the results do not support arguments that patients are insensitive to price when changing their doctors. CONCLUSIONS: Despite the removal of part-charges for children, financial barriers remain significant for many low income adults. To a large extent these barriers reflect the nature of welfare reform, particularly the detrimental effects of pro-market housing policies in limiting the disposable incomes of poorer New Zealanders.