Voting with their feet: patient exit and intergroup differences in propensity for switching usual source of care

Many analysts advocate patient exit as a strategy for consumers who experience poor-quality care. Exit is believed to have the potential to improve patient welfare by having patients leave (or "exit") poor-performing health care providers, thus signaling their dissatisfaction with the quality of care they have received and thereby admonishing those providers to improve. However, the validity of exit as a signal of consumer dissatisfaction hinges on how closely it reflects dissatisfaction. Intergroup differences in the propensity to exit could also result in unintended consequences. This article examines the association between consumer experience and the decision to change one's usual care providers. It also investigates if there are any intergroup differences in the propensity for changing providers according to insurance status, gender, and race or ethnicity. Data come from household surveys conducted by the Center for Studying Health System Change. Results show significant intergroup differences in propensity for switching usual source of care for voluntary or involuntary reasons related to insurance, rural residency, age, income, race, and ethnicity. Policy implications of the empirical results on exit, voice, and consumerism are discussed.