Models of man and models of policy: reflections of "Exit, Voice, and Loyalty" ten years later.

The challenge of health care policy is how to combine sensitivity to both consumer preferences (the economic model) and citizen wishes (the political model): what either wants the other may wish to deny him. Competing economic (exit) and political (voice) activities in response to deterioration in the quality of a service, however, may be an inadequate framework to encompass discontent with the complex mix of types of services offered. The "political market" in which decisions about health care are made is suggested for further exploration.