--- title: "Pt exit and intergroup diffs in switching care source. | Sutter Health" description: "Data show signif intergroup diffs in propensity for switching usual source of care for voluntary/involuntary reasons--insur, rural residence, age, income, race." url: "https://www.sutterhealth.org/research/publications/pt-exit-intergrp-diffs-switch-care-source-1055312541" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Pt exit and intergroup diffs in switching care source. # Voting with their feet: patient exit and intergroup differences in propensity for switching usual source of care. Tai-Seale M. _J Health Polit Policy Law. 29(3):491-514._ 2004-06-01 ## Abstract It is believed to have the potential to improve patient welfare by having patients leave (or "exit") poor-performing health care providers, thus signaling their dissatisfaction with the quality of care they have received and thereby admonishing those providers to improve. However, the validity of exit as a signal of consumer dissatisfaction hinges on how closely it reflects dissatisfaction. Intergroup differences in the propensity to exit could also result in unintended consequences. This article examines the association between consumer experience and the decision to change one's usual care providers. It also investigates if there are any intergroup differences in the propensity for changing providers according to insurance status, gender, and race or ethnicity. Data come from household surveys conducted by the Center for Studying Health System Change. Results show significant intergroup differences in propensity for switching usual source of care for voluntary or involuntary reasons related to insurance, rural residency, age, income, race, and ethnicity. Policy implications of the empirical results on exit, voice, and consumerism are discussed. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/15328875) ## Research topics - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [The impact of threshold language assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting.](https://www.sutterhealth.org/research/publications/language-help-and-access-to-mental-health-services-1055312803) McClellan SR, Wu FM, Snowden LR. Med Care. 50(6):554-8. doi: 10.1097/MLR.0b013e3182463432. 2012 Jun 01 - Publication ### [Association of mandated language access programming and quality of care provided by mental health agencies.](https://www.sutterhealth.org/research/publications/lang-access-care-quality-mental-health-agencies-1055312895) McClellan SR, Snowden L. Psychiatr Serv. 2014 Sep 15. doi: 10.1176/appi.ps.201300522. \[Epub ahead of print\] 2014 Sep 15 - Publication ### [The long-term effects of Medicaid managed care on obstetrics care in three California counties.](https://www.sutterhealth.org/research/publications/medicaid-managed-care-obstetrics-ca-counties-1055312574) Tai-Seale M, LoSasso AT, Freund DA, Gerber SE. Health Serv Res. 36(4):751-71. 2001 Aug 01 - Publication ### [The centralization of robotic surgery in high-volume centers for endometrial cancer patients--a study of 6560 cases in the U.S.](https://www.sutterhealth.org/research/publications/central-robotic-surery-centers-endometrial-cancer-1055312938) Chan JK, Gardner AB, Taylor K, Blansit K, Thompson CA, Brooks R, Yu X, Kapp DS. Gynecol Oncol. 2015 Jul;138(1):128-32. doi: 10.1016/j.ygyno.2015.04.031. Epub 2015 Apr 28. 2015 Jul 01 - Publication ### [An evaluation of two interventions to enhance patient-physician communication using the observer OPTION5 measure of shared decision making.](https://www.sutterhealth.org/research/publications/eval-2-interv-enhance-pt-md-comm-option5-measure-1055312393) Dillon EC, Stults CD, Wilson C, Chuang J, Meehan A, Li M, Elwyn G, Frosch DL, Yu E, Tai-Seale M. Patient Educ Couns. pii: S0738-3991(17)30254-9. doi: 10.1016/j.pec.2017.04.020. \[Epub ahead of print\] 2017 May 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/pt-exit-intergrp-diffs-switch-care-source-1055312541#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Pt exit and intergroup diffs in switching care source."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/pt-exit-intergrp-diffs-switch-care-source-1055312541#medicalscholarlyarticle","name":"Voting with their feet: patient exit and intergroup differences in propensity for switching usual source of care.","headline":"Pt exit and intergroup diffs in switching care source.","abstract":"It is believed to have the potential to improve patient welfare by having patients leave (or \"exit\") poor-performing health care providers, thus signaling their dissatisfaction with the quality of care they have received and thereby admonishing those providers to improve. However, the validity of exit as a signal of consumer dissatisfaction hinges on how closely it reflects dissatisfaction. Intergroup differences in the propensity to exit could also result in unintended consequences. This article examines the association between consumer experience and the decision to change one's usual care providers. It also investigates if there are any intergroup differences in the propensity for changing providers according to insurance status, gender, and race or ethnicity. Data come from household surveys conducted by the Center for Studying Health System Change. Results show significant intergroup differences in propensity for switching usual source of care for voluntary or involuntary reasons related to insurance, rural residency, age, income, race, and ethnicity. 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