In some countries, including France, patients can choose between consulting a physician working in the regulated sector (where, in general, fees are fully covered by health insurance) and a physician working in the unregulated sector (where a balance-billing scheme operates). In the latter, patients must make out-of-pocket payments. The paper analyzes the signalling properties of this mechanism. The model reveals that a small extra fee allows obtaining a separating equilibrium in which only patients with a high propensity to adhere to the treatment will opt for the unregulated sector and will benefit from a larger care effort on the part of their physician. We also analyze the other equilibria of the game.
BESANCENOT, D., LAMIRAUD, K. et VRANCEANU, R. (2021). Balance Billing as an Adherence-to-Treatment Signalling Device. Journal of Institutional and Theoretical Economics, 177(3), pp. 359-390.