Exit, Voice, Governance and User Responsiveness : The Case of English Primary Care Trusts  

Oleh:

Pickard, Susan ; Sheaff, Rod ; Dowling, Bernard

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 63 no. 2 (Jul. 2006), page 373-383.
Topik: PRIMARY CARE; exit; voice; governance; primary care; england; quasi market; UK

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.5 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

Hirschman contrasts exit and voice as recuperation mechanisms for making organisations responsive to users. However, the emergence of health care quasi markets and of network governance structures since hirschman necessitate reevising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs) this paper analyses the recuperation mechnaisms, governance structures and relations between them in primary care in england. User voice can be exercised through dedicated networks besides hierarchies. As well as the user exist described by hirschman, two new exit mechanisms now exist in quasi markets. Commissioner exit occurs when a third party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund holder (or analogous budget holder) behaves similarly. Neither exit mechanisms requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of english PCTs illustrates.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali