Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study

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.