Cream skimming and discrimination in access to medical care: A field experiment

This study measures the differences in access to healthcare for female patients in France in three medical specialties (dentistry, gynecology and psychiatry) according to two criteria: the African ethnicity of the patient and the benefit of having means-tested health insurance coverage. To this purpose, we conducted a nationally representative field experiment on more than 1500 physicians. We do not find substantial discrimination against the patient of African origin. However, the results indicate that patients with means-tested health insurance coverage are less likely to get an appointment. Differentiating between two types of coverage, we show that the lesser-known coverage (ACS) is more penalized than the other (CMU-C) as poor knowledge of the program increases the physician's expectation of additional administrative tasks and is an important element to explain cream-skimming. We also find that, for physicians who are free to set their fees, the opportunity cost of accepting a means-tested patient increases the penalty. Finally, the results suggest that enrollment in OPTAM, the controlled pricing practice option that incentivizes physicians to accept means-tested patients, reduces cream-skimming.