Balance Billing as an Adherence-to-Treatment Signalling Device

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.