"Exit, Voice, and Loyalty:" further reflections and a survey of recent contributions.

Three years after publication of Exit, Voice, and Loyalty: Responses to Decline in firms, Organizations, and States, Professor Hirschman was called upon to extend his consideration of uses of economic modes of reasoning to dissect political phenomena. The exit-voice framework is extended in connection with the search for optimal ways of organizing public services--from the State itself to day care, to the British National Health Service. These little-known further reflections are reprinted as a service to the increasing number of students of exit-voice themes in health services.