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

Outpatient specialist physicians in France can work either in the regulated sector, where they charge the regulated fee, or in the unregulated sector, where they set their own fees above the regulated fee. This context provides a unique opportunity to estimate the extent to which patients value services provided under balance billing. In January 2021, we carried out a contingent valuation method (CVM) survey on a sample of 1051 individuals who were representative of France's adult population. Results highlighted that willingness-to-pay (WTP) for a specialist consultation in the unregulated sector was higher than for a consultation in the regulated sector, with a significant WTP difference of €4.30 (almost 15% of the regulated fee). This difference was significant across all respondent subgroups (i.e., gender, age, education level, marital status, income, health status, insurance coverage, and area of residence) and was not fully driven by differences in income. Moreover, this preference for the unregulated sector was associated with the perception that specialists in this sector provide better quality medical care, better quality non-medical services, and that making an appointment with them is easier. Finally, we estimated the patient net welfare gain generated by specialist consultations in the unregulated sector in France at approximately €165 million per year. This is the first study to provide an estimation of patients' benefits associated with balance billing.