Do Patients Value the Service Provided by Physicians Who Overbill? A Willingness-to-Pay Study Using French Survey...

Area of Science:

• Health Economics
• Medical Services Research
• Patient Behavior Analysis

Background:

• French outpatient specialist physicians operate in regulated (fixed fee) and unregulated (balance billing) sectors.
• This dual system offers a unique setting to assess patient valuation of services with flexible pricing.

Purpose of the Study:

• To quantify patient willingness-to-pay (WTP) for specialist consultations in the unregulated sector compared to the regulated sector.
• To identify factors influencing patient preferences for balance-billed services.
• To estimate the overall patient welfare gain from unregulated specialist services in France.

Main Methods:

• A contingent valuation method (CVM) survey was conducted in January 2021.
• The survey included 1051 individuals representative of the French adult population.
• Statistical analysis examined WTP differences across demographic and health-related subgroups.

Main Results:

• Patients demonstrated a significantly higher WTP for unregulated sector consultations (€4.30 more, ~15% of regulated fee).
• This preference was consistent across diverse respondent subgroups and not solely income-driven.
• Perceived higher quality of medical and non-medical services, and easier appointment scheduling, drove the preference for the unregulated sector.
• Estimated annual patient net welfare gain from unregulated specialist services in France is approximately €165 million.

Conclusions:

• Patients in France derive substantial welfare gains from the balance billing system in specialist care.
• Patient preferences for the unregulated sector are linked to perceived quality improvements and accessibility.
• This study provides the first estimation of patient benefits associated with balance billing in specialist healthcare.