Samenvatting

Alfred Hirschman has analyzed consumers reactions of 'voice' and 'exit' with respect to the functioning of public and private organizations. He has argued that the value of 'voice' to articulate dissatisfaction with respect to public and private organisations is often misunderstood. Especially with respect to so-called complex goods, voice is far more fruitful to explore the norms for 'best practice' and to stimulate the improvement of the organisation than exit. Insurance might be seen as a complex good. From the perspective of Hirschman we analysed the exit- and voice options of citizens with respect to private and public health insurance. We argue that while private insurance offers more exit-options, the quality of the voice options in private insurance might be considered better. However, the opportunities to articulate disagreement or dissatisfaction on an individual level are few all together. Public health insurance does have formal channels for collective voice, but these do not result in real influence on relevant themes. With the reorganization of the Dutch welfare state, much has been invested, ideological and practical, in the increase of exit options. However, dissatisfaction often does develop when people have become ill and when they are dependent upon the insurance. In that situation they often are not able to walk out to a competing company or to perform voice. Against this background we argue that the organisation of collective voice in health insurance is very important.