Table 4 VBHC may undermine solidarity by favouring exit over voice

Mrs. Z., a wealthy widow, visits an orthopaedist in her local, public hospital. On her first appointment at the outpatient ward, there appears to be ‘no love lost’ between her and her doctor, to put it mildly. Mrs. Z. leaves the hospital feeling very offended and insulted. That very evening she visits a website where patients can post reviews of their experiences with doctors. She writes a critical review, and she also uses the ‘find your doctor’ function to choose a different orthopaedist; this time in a private clinic.

One week later, Mrs. Z. tells her story to her brother in law, Mr. J., who is not that well-established. He was not even aware of the fact that patients are ‘allowed’ to change doctors. Let alone that he knew the place on the internet where comparisons between health care providers can be made. He wonders what will happen if all people like Mrs. Z. will ‘leave the public system’. Deep in his heart, it makes him feel a second-rate civilian, who is left with inferior health care facilities.