title: An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel.
abstract: 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.
authors.affiliation: Department of Public Administration and Policy, School of Political Sciences, The University of Haifa, Haifa, Israel.
authors.forename: Nissim
authors.initials: N
authors.lastname: Cohen
authors.affiliation: Department of Politics and Government, Ben-Gurion University of the Negev, Beersheba, Israel.
authors.forename: Dani
authors.initials: D
authors.lastname: Filc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D005260:Female; D005382:Financing, Personal / Q000379:methods*; D005102:Health Expenditures; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011795:Surveys and Questionnaires
keywords: black market medicine; exit; informal payments; loyalty; voice