Exit, Voice and Frailty: Consumer Behavior Under Managed Competition

What is the relationship between health care consumers’ willingness and ability to exit health plan enrollment, and their voice or willingness to complain in order to improve their care and satisfaction? According to researchers at Yale University and Harris Allen Associates, managed competition models rely on exit as the primary safeguard for quality. Consumers can exit if they are dissatisfied with care. Yet we know little about consumers’ real ability to exit plans (Are there other plans available? What are the ramifications of exiting?). Nor is there much literature on voice and consumers’ willingness to complain or make their feelings known to plans. This project analyzed data from the Employee Health Care Value Survey, a two-stage employee survey fielded by three large corporations in 1993 and 1995. The survey has a range of managed care models, a relatively large sample, and data on health status, sociodemographic factors, and satisfaction with plan measures. The objective of the study was to identify enrollee characteristics that facilitate (or are associated with) health plan exit (disenrollment) and voice (complaints) to help assess the true feasibility of the managed competition model.