IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v63y2006i2p373-383.html
   My bibliography  Save this article

Exit, voice, governance and user-responsiveness: The case of English primary care trusts

Author

Listed:
  • Pickard, Susan
  • Sheaff, Rod
  • Dowling, Bernard

Abstract

Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasi-markets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates.

Suggested Citation

  • Pickard, Susan & Sheaff, Rod & Dowling, Bernard, 2006. "Exit, voice, governance and user-responsiveness: The case of English primary care trusts," Social Science & Medicine, Elsevier, vol. 63(2), pages 373-383, July.
    • Handle: RePEc:eee:socmed:v:63:y:2006:i:2:p:373-383
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(06)00009-8
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Stevenson, Fiona A. & Barry, Christine A. & Britten, Nicky & Barber, Nick & Bradley, Colin P., 2000. "Doctor-patient communication about drugs: the evidence for shared decision making," Social Science & Medicine, Elsevier, vol. 50(6), pages 829-840, March.
    3. Jewkes, Rachel & Murcott, Anne, 1998. "Community representatives: Representing the "community"?," Social Science & Medicine, Elsevier, vol. 46(7), pages 843-858, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gale, Nicola & Dowswell, George & Greenfield, Sheila & Marshall, Tom, 2017. "Street-level diplomacy? Communicative and adaptive work at the front line of implementing public health policies in primary care," Social Science & Medicine, Elsevier, vol. 177(C), pages 9-18.
    2. Vengberg, Sofie & Fredriksson, Mio & Winblad, Ulrika, 2019. "Patient choice and provider competition – Quality enhancing drivers in primary care?," Social Science & Medicine, Elsevier, vol. 226(C), pages 217-224.
    3. Valentine, Nicole & Darby, Charles & Bonsel, Gouke J., 2008. "Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries," Social Science & Medicine, Elsevier, vol. 66(9), pages 1939-1950, May.
    4. Macq, Jean & Martiny, Patrick & Villalobos, Luis Bernardo & Solis, Alejandro & Miranda, Jose & Mendez, Hilda Cecilia & Collins, Charles, 2008. "Public purchasers contracting external primary care providers in Central America for better responsiveness, efficiency of health care and public governance: Issues and challenges," Health Policy, Elsevier, vol. 87(3), pages 377-388, September.
    5. Nissim Cohen & Dani Filc, 2017. "An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 72-90, January.
    6. Chung, Phillip & Grogan, Colleen M. & Mosley, Jennifer E., 2012. "Residents' perceptions of effective community representation in local health decision-making," Social Science & Medicine, Elsevier, vol. 74(10), pages 1652-1659.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Solomon, Josie & Knapp, Peter & Raynor, D.K. & Atkin, Karl, 2013. "Worlds apart? An exploration of prescribing and medicine-taking decisions by patients, GPs and local policy makers," Health Policy, Elsevier, vol. 112(3), pages 264-272.
    2. Armstrong, David, 2023. "The social life of risk probabilities in medicine," Social Science & Medicine, Elsevier, vol. 323(C).
    3. E.A.G. Joosten & G.H. De Weert-Van Oene & T. Sensky & C.P.F. Van Der Staak & C.A.J. De Jong, 2011. "Treatment Goals in Addiction Healthcare: the Perspectives of Patients and Clinicians," International Journal of Social Psychiatry, , vol. 57(3), pages 263-276, May.
    4. Nora Moumjid & Amiram Gafni & Alain Brémond & Marie-Odile Carrère, 2007. "Shared Decision Making in the Medical Encounter: Are We All Talking about the Same Thing?," Medical Decision Making, , vol. 27(5), pages 539-546, September.
    5. Polak, Louisa & Green, Judith, 2020. "Rethinking decision-making in the context of preventive medication: How taking statins becomes “the right thing to do”," Social Science & Medicine, Elsevier, vol. 247(C).
    6. Flynn, Kathryn E. & Smith, Maureen A. & Vanness, David, 2006. "A typology of preferences for participation in healthcare decision making," Social Science & Medicine, Elsevier, vol. 63(5), pages 1158-1169, September.
    7. Manuel Antonio Espinoza & Andrea Manca & Karl Claxton & Mark Sculpher, 2018. "Social value and individual choice: The value of a choice‐based decision‐making process in a collectively funded health system," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 28-40, February.
    8. Hyojung Tak & Gregory Ruhnke & Ya-Chen Shih, 2015. "The Association between Patient-Centered Attributes of Care and Patient Satisfaction," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 8(2), pages 187-197, April.
    9. Miller, Nancy & Weinstein, Marcie, 2007. "Participation and knowledge related to a nursing home admission decision among a working age population," Social Science & Medicine, Elsevier, vol. 64(2), pages 303-313, January.
    10. France Légaré & Annette M. O'Connor & Ian D. Graham & Georges A. Wells & Stéphane Tremblay, 2006. "Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict," Medical Decision Making, , vol. 26(4), pages 373-390, July.
    11. Odette Wegwarth & Wolfgang Gaissmaier & Gerd Gigerenzer, 2011. "Deceiving Numbers," Medical Decision Making, , vol. 31(3), pages 386-394, May.
    12. Karnieli-Miller, Orit & Eisikovits, Zvi, 2009. "Physician as partner or salesman? Shared decision-making in real-time encounters," Social Science & Medicine, Elsevier, vol. 69(1), pages 1-8, July.
    13. Paul C. Schroy III & Karen Emmons & Ellen Peters & Julie T. Glick & Patricia A. Robinson & Maria A. Lydotes & Shamini Mylvanaman & Stephen Evans & Christine Chaisson & Michael Pignone & Marianne Prout, 2011. "The Impact of a Novel Computer-Based Decision Aid on Shared Decision Making for Colorectal Cancer Screening," Medical Decision Making, , vol. 31(1), pages 93-107, January.
    14. Mei-Chun Cheung & Derry Law & Joanne Yip & Jason Pui Yin Cheung, 2022. "Adolescents’ Experience during Brace Treatment for Scoliosis: A Qualitative Study," IJERPH, MDPI, vol. 19(17), pages 1-10, August.
    15. Meike Müller-Engelmann & Norbert Donner-Banzhoff & Heidi Keller & Lydia Rosinger & Carsten Sauer & Kerstin Rehfeldt & Tanja Krones, 2013. "When Decisions Should Be Shared," Medical Decision Making, , vol. 33(1), pages 37-47, January.
    16. Margaret Gerteis & Rosemary Borck, "undated". "Shared Decision-Making in Practice: Lessons from Implementation Efforts," Mathematica Policy Research Reports f802e52b8442486594ecda927, Mathematica Policy Research.
    17. Mark Sculpher & Amiram Gafni, 2001. "Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 317-324, June.
    18. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    19. Ruth Astbury & Ashley Shepherd & Helen Cheyne, 2017. "Working in partnership: the application of shared decision‐making to health visitor practice," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(1-2), pages 215-224, January.
    20. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:63:y:2006:i:2:p:373-383. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.