Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study
File(s)
Published version
Author(s)
Greenfield, Geva
Type
Journal Article
Abstract
Objectives: To evaluate the utilization (overall and by specialty) and the characteristics of
second-opinion seekers by insurance type (either health-fund or supplementary insurance) in
a mixed private-public healthcare.
Design: An observational study.
Setting: Secondary care visits provided by a large public health-fund and a large
supplementary health insurance in Israel.
Participants: The entire sample included 1,392,907 patients age 21 and above who visited at
least one specialist over an 18-months period, either in the secondary care or privately via the
supplementary insurance.
Outcomes measures: An algorithm was developed to identify potential second-opinion
instances in the dataset using visits and claims data. Multivariate logistic regression was used
to identify characteristics of second-opinion seekers by the type of insurance they utilized.
Results: 143,371 (13%) out of 1,080,892 patients who had supplementary insurance sought a
single second-opinion, mostly from orthopedic surgeons. Relatively to patients who sought
second-opinion via the supplementary insurance, second-opinion seekers via the health-fund
tended to be females (OR=1.2, 95% CI 1.17–1.23), of age 40-59 (OR= 1.36, 95% CI 1.31–
1.42) and with chronic conditions (OR=1.13, 95% CI 1.08–1.18). In contrast, second-opinion
seekers via the supplementary insurance tended to be native-born and established immigrants
(OR=0.79, 95% CI 0.76–0.84), in a high socio-economic level (OR= 0.39, 95% CI 0.37–0. 4)
and living in central areas (OR= 0.88, 95% CI 0.85–0.9).
Conclusions: Certain patient profiles tended to seek second-opinions via the supplementary
insurance more than others. People from the center of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas.
second-opinion seekers by insurance type (either health-fund or supplementary insurance) in
a mixed private-public healthcare.
Design: An observational study.
Setting: Secondary care visits provided by a large public health-fund and a large
supplementary health insurance in Israel.
Participants: The entire sample included 1,392,907 patients age 21 and above who visited at
least one specialist over an 18-months period, either in the secondary care or privately via the
supplementary insurance.
Outcomes measures: An algorithm was developed to identify potential second-opinion
instances in the dataset using visits and claims data. Multivariate logistic regression was used
to identify characteristics of second-opinion seekers by the type of insurance they utilized.
Results: 143,371 (13%) out of 1,080,892 patients who had supplementary insurance sought a
single second-opinion, mostly from orthopedic surgeons. Relatively to patients who sought
second-opinion via the supplementary insurance, second-opinion seekers via the health-fund
tended to be females (OR=1.2, 95% CI 1.17–1.23), of age 40-59 (OR= 1.36, 95% CI 1.31–
1.42) and with chronic conditions (OR=1.13, 95% CI 1.08–1.18). In contrast, second-opinion
seekers via the supplementary insurance tended to be native-born and established immigrants
(OR=0.79, 95% CI 0.76–0.84), in a high socio-economic level (OR= 0.39, 95% CI 0.37–0. 4)
and living in central areas (OR= 0.88, 95% CI 0.85–0.9).
Conclusions: Certain patient profiles tended to seek second-opinions via the supplementary
insurance more than others. People from the center of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas.
Date Issued
2019-07-27
Date Acceptance
2019-07-03
Citation
BMJ Open, 2019, 9 (7), pp.1-10
ISSN
2044-6055
Publisher
BMJ Journals
Start Page
1
End Page
10
Journal / Book Title
BMJ Open
Volume
9
Issue
7
Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Identifier
https://bmjopen.bmj.com/content/9/7/e025673
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
CANCER-PATIENTS
2ND-OPINION
SEEKING
DETERMINANTS
DISPARITIES
SERVICES
PROGRAM
REFORMS
DEMAND
RATES
public health fund
second medical opinion
supplementary healthcare insurance
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status
Published
Date Publish Online
2019-07-27