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

Dissatisfied users of public services may choose to voice or exit. But when does emerge? To answer this question, we deploy Hirschman’s exit, voice, and loyalty (EVL) model. We set out an ‘available alternatives’ hypothesis—increasing the number exit options reduces voice—in contrast ‘effective voice’ hypothesis where is lower there no choice. expect exit-voice relationship be moderated by loyalty; providers that respond user improve satisfaction reduce evaluate these hypotheses in a survey experiment on publicly funded doctors’ UK. find effects nor evidence for as moderator. A response provider results higher intention strengthened loyalty. Providers can promote discourage moving alternative responding voice.