Social class differences in coping with a physicians' strike in Israel.

Area of Science:

• Health Services Research
• Socioeconomic Determinants of Health
• Public Health Policy

Background:

• The 1983 Israeli physicians' strike created a natural experiment in healthcare delivery.
• Alternative Care Centers (ACC) operated on a fee-for-service model, contrasting with the usual prepaid system.
• Primary medical care was accessible via ACCs and open hospital emergency rooms.

Purpose of the Study:

• To compare how different educational levels experienced and adapted to the strike.
• To analyze health behaviors, utilization patterns, costs, satisfaction, and perceived health damage.
• To understand the impact of socioeconomic status on healthcare access during a service disruption.

Main Methods:

• A comparative study analyzing data from 719 self-administered questionnaires.
• Data collected from primary care clinics and university employees.
• Examined expressed need, health behavior, service utilization, expenses, satisfaction, and perceived health damage across educational strata.

Main Results:

• Lower education groups reported higher physician care needs and perceived health damage.
• All groups responded similarly to urgent needs, but lower socioeconomic groups reported less satisfaction and more damage.
• In non-urgent situations, lower socioeconomic groups had higher utilization and expenses without better outcomes.

Conclusions:

• Lower socioeconomic groups cope less effectively with healthcare service disruptions due to resource limitations.
• Educational attainment significantly influences the experience and outcomes of healthcare system changes.
• Targeted support may be necessary for vulnerable populations during health service interruptions.