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The Scientific World Journal
Volume 2013, Article ID 292745, 9 pages
Research Article

Exit, Voice, and Loyalty in the Italian Public Health Service: Macroeconomic and Corporate Implications

1Research and Development Board, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy
2Department of Studies and Business Research, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano Salerno, Italy

Received 28 August 2013; Accepted 27 September 2013

Academic Editors: E. Carbone and M. Fanucchi

Copyright © 2013 Adelaide Ippolito et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The paper analyses how customers of public health organizations can express their dissatisfaction for the services offered to them. The main aim is to evaluate the effects that possible dissatisfaction of Italian public health service customers can have on public health organizations. We adopted the methodological scheme developed by Hirschman with exit, voice, and loyalty, considering the macroeconomic and corporate implications that it causes for Italian public health organizations. The study investigated the effects developed by exit of the patients on the system of financing of local health authorities considering both the corporate level of analysis and the macroeconomic level. As a result, local health authority management is encouraged to pay greater attention to the exit phenomena through the adoption of tools that promote loyalty, such as the promotion of voice, even if exit is not promoting, at a macroeconomic level, considerable attention to this phenomenon.