Testing Hirschman’s exit, voice, and loyalty model: citizen and provider responses to decline in public health services

Figures & data

Table 1. Mean levels of voice and efficacy by experimental condition.

	No choice	Minimal choice	Extensive choice	Diff (No-Ltd)	Diff (Ltd-Ext)
Individual voice	5.18	5.05	5.03	0.13	0.2
Collective voice	4.89	4.95	4.76	–0.06	0.19
Individual efficacy	5.45	5.45	5.29	0.0	0.16
Collective efficacy	5.70	5.77	5.51	–0.07	0.26

Table 2A. Individual voice moderated by loyalty, OLS regression.

	(1)	(2)	(3)	(4)	(5)	(6)
Variables	Individual voice	Individual voice	Individual voice	Individual voice	individual voice	Individual voice
Limited choice	–0.322	0.133		–0.0881	–0.00748
	(0.278)	(0.279)		(0.358)	(0.365)
Extensive choice	–0.455		–0.133	–0.0806		0.00748
	(0.286)		(0.279)	(0.360)		(0.365)
No choice		0.455	0.322		0.0806	0.0881
		(0.286)	(0.278)		(0.360)	(0.358)
Time with GP	–0.0298**	–0.0104	–0.0172*
	(0.00927)	(0.00834)	(0.00806)
Limited Choice * Time with GP	0.0126	–0.00683
	(0.0123)	(0.0116)
Extensive Choice * Time with GP	0.0194		0.00683
	(0.0125)		(0.0116)
No Choice * Time with GP		–0.0194	–0.0126
		(0.0125)	(0.0123)
Switched provider				0.310***	0.287***	0.294***
				(0.0465)	(0.0473)	(0.0473)
t2switch				–0.0158	0.00786
				(0.0663)	(0.0669)
t3switch				–0.0236		–0.00786
				(0.0663)		(0.0669)
t1switch					0.0236	0.0158
					(0.0663)	(0.0663)
Constant	5.678***	5.223***	5.356***	3.737***	3.656***	3.649***
	(0.202)	(0.203)	(0.191)	(0.250)	(0.260)	(0.256)
Observations	1,528	1,528	1,528	1,528	1,528	1,528
R-squared	0.011	0.011	0.011	0.074	0.074	0.074

Standard errors in parentheses.

*** p < 0.001.

** p < 0.01.

* p < 0.05

Table 2B. Collective voice moderated by loyalty, OLS regression.

	(1)	(2)	(3)	(4)	(5)	(6)
Variables	Collective voice	Collective voice	Collective voice	Collective voice	Collective voice	Collective voice
Limited choice	–0.263	0.236		0.284	0.577
	(0.275)	(0.276)		(0.349)	(0.356)
Extensive choice	–0.499		–0.236	–0.292		–0.577
	(0.283)		(0.276)	(0.352)		(0.356)
No choice		0.499	0.263		0.292	–0.284
		(0.283)	(0.275)		(0.352)	(0.349)
Time with GP	–0.0353***	–0.0117	–0.0148
	(0.00917)	(0.00826)	(0.00798)
Limited Choice*Time GP	0.0205	–0.00320
	(0.0122)	(0.0115)
Extens Choice*Time GP	0.0237		0.00320
	(0.0123)		(0.0115)
No Choice * Time GP		–0.0237	–0.0205
		(0.0123)	(0.0122)
Switched provider				0.355***	0.379***	0.300***
				(0.0454)	(0.0462)	(0.0461)
Limited Choice*Time GP				–0.0543	–0.0787
				(0.0647)	(0.0653)
Extens Choice*Time GP				0.0244		0.0787
				(0.0647)		(0.0653)
No Choice * Time GP					–0.0244	0.0543
					(0.0647)	(0.0647)
Constant	5.480***	4.982***	5.218***	3.239***	2.947***	3.524***
	(0.200)	(0.201)	(0.190)	(0.244)	(0.254)	(0.250)
Observations	1,528	1,528	1,528	1,528	1,528	1,528
R-squared	0.014	0.014	0.014	0.102	0.102	0.102

Standard errors in parentheses.

*** p < 0.001.

** p < 0.01.

* p < 0.05.

Figure 1. Impact of response on satisfaction.

Figure 2. Impact of response on intentions to exit.

Table 3. Reactions to responses from GP moderated by loyalty and switching behaviors, OLS regressions.

	(1)	(2)	(3)	(4)
	Satisfaction with GP	Satisfaction with GP	Intention to leave	Intention to leave
Response GP	2.886***	3.850***	–0.281	–1.951***
	(0.198)	(0.262)	(0.257)	(0.346)
Time with GP	–0.0339***		–0.00619
	(0.00586)		(0.00740)
Response * Time with GP	0.0225**		–0.0476***
	(0.00850)		(0.0107)
Switched		0.226***		0.151***
		(0.0340)		(0.0452)
Response * Switched		–0.117*		0.163*
		(0.0482)		(0.0634)
Constant	3.989***	2.307***	6.571***	5.747***
	(0.139)	(0.184)	(0.180)	(0.242)
Observations	1,528	1,528	1,022	1,022
R-squared	0.313	0.321	0.085	0.096

Standard errors in parentheses.

*** p < 0.001.

** p < 0.01.

* p < 0.05.

Figure 3. (a) Satisfaction and switching, p = 0.0000. (b) Satisfaction and time with GP, p = 0.0004. (c) Exit and switching, p = 0.0280. (d) Exit and time with GP, p = 0.6491.