An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel. (31st July 2015)

• Record Type: Journal Article
• Authors: Cohen, Nissim; Filc, Dani
• Is Part Of: International journal of health planning and management. Volume 32:Number 1(2017)
• Page Start: 72
• Page End: 90
• Publication Date: 2015-07-31
• Subjects: informal payments -- black market medicine -- exit -- voice -- loyalty; Health planning -- Periodicals; Health services administration -- Periodicals; Santé publique -- Planification -- Périodiques; Santé, Services de -- Administration -- Périodiques; 362.1068
• DOI: 10.1002/hpm.2309
• Languages: English
• ISSNs: 0749-6753

Abstract

Summary: This study examines Hirschman's model of exit, voice and loyalty with regard to informal payments in the Israeli healthcare system. Based on a national survey, we investigate the extent of "black" payments, its characteristics and its correlated factors. We find that informal payments do exist in Israel—although it seems that there has been a decline in the phenomenon. Contrary to the literature, we find no relationship between the option of voice or dissatisfaction with healthcare services and informal payments. However, we do find a negative correlation between trust and the use of such payments. This finding is consistent with Hirschman's insight that a lack of loyalty may lead people to strategies of exit. We suggest that given the fact that health care in Israel is a public service, the exit option may actually be a quasi‐exit behavior. Copyright © 2015 John Wiley & Sons, Ltd.