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

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Abstract
The 1983 physicians' strike in Israel lasted 118 days. Striking physicians established alternative medical care centers (ACC) providing primary and specialized medical care on a fee for service basis. This contrasted with the usual pre-paid health insurance system, and provides an interesting natural experiment in health care services. Hospital emergency rooms remained open during the strike. Thus, primary medical care was available in these two settings. This paper compares people of different educational levels as they experienced and adapted to this strike with regard to their expressed need for physicians, their health behavior and outcomes in terms of patterns of utilization of the two services, financial expenses, satisfaction with the ACC's and perceived damage to health caused by the strike. The data were extracted from 719 self-administered questionnaires which were distributed in 14 primary care clinics and among university employees. The results show that the groups with lower levels of education, as compared to groups with higher education levels, reported more need for physicians' care and more damage to health. They were, however, less critical of the parties involved in the strike. When urgent need was reported, all respondents behaved similarly; however, people of lower social classes reported less satisfaction and perceived more damage. In non-urgent need conditions, although lower class respondents had higher utilization rates and higher expenses, they achieved no better results than the higher classes. It is suggested that due to a relative lack of psychological, social and financial resources, people of lower socio-economic classes cope less effectively with sudden changes in the provision of health services.

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