Voice and choice in health care in England: understanding citizen responses to dissatisfaction

Public Adm. 2011;89(4):1403-418. doi: 10.1111/j.1467-9299.2011.01960.x.


Using data from a five-year online survey the paper examines the effects of relative satisfaction with health services on individuals' voice-and-choice activity in the English public health care system. Voice is considered in three parts – individual voice (complaints), collective voice voting and participation (collective action). Exercising choice is seen in terms of complete exit (not using health care), internal exit (choosing another public service provider) and private exit (using private health care). The interaction of satisfaction and forms of voice and choice are analysed over time. Both voice and choice are correlated with dissatisfaction with those who are unhappy with the NHS more likely to privately voice and to plan to take up private health care. Those unable to choose private provision are likely to use private voice. These factors are not affected by items associated with social capital – indeed, being more trusting leads to lower voice activity.

Publication types

  • Historical Article

MeSH terms

  • Choice Behavior*
  • Consumer Behavior* / economics
  • Consumer Behavior* / legislation & jurisprudence
  • England / ethnology
  • Health Services* / economics
  • Health Services* / history
  • Health Services* / legislation & jurisprudence
  • History, 20th Century
  • History, 21st Century
  • National Health Programs* / economics
  • National Health Programs* / history
  • National Health Programs* / legislation & jurisprudence
  • Public Opinion* / history