When Choice Becomes a Duty and Voice is Limited

This article investigates elements of healthcare consumerism in Germany from a user-centred perspective. Following Albert Hirschman’s well-known framework of exit and voice and using current choice-and-competition discourses as a theoretical backdrop, it will examine the key principles and the embeddedness of the German corporatist healthcare system. Despite a de facto pluralization of healthcare services, the extension of users’ choice has not been a prime policy objective but rather a half-heartedly intended by-product. Instead, cost containment and a limited notion of healthcare users as participating subjects have dominated policy reforms. Using empirical examples, it will be argued that, in the German context in particular, the integration of greater choice among healthcare services with user-enabling strategies is underdeveloped. Furthermore, healthcare users in Germany, perceiving universal coverage as a crucial part of their citizenship rights, have not yet adapted to the consumerist shift in the healthcare system.