Responsive consumerism: Empowerment in markets for health plans

Brian Elbel, Mark Schlesinger

Research output: Contribution to journalReview articlepeer-review


Context: American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans. Methods: Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered." Findings: The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this. Conclusions: While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.

Original languageEnglish (US)
Pages (from-to)633-682
Number of pages50
JournalMilbank Quarterly
Issue number3
StatePublished - Sep 2009


  • Consumerism
  • Exit
  • Health plans
  • Markets
  • Responsive consumerism
  • Voice

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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