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.
|Number of pages||19|
|Journal||International Journal of Health Planning and Management|
|State||Published - 1 Jan 2017|
Bibliographical notePublisher Copyright:
Copyright © 2015 John Wiley & Sons, Ltd.
- black market medicine
- informal payments
ASJC Scopus subject areas
- Health Policy