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Comparative Study
. 2019 Apr 23;19(1):238.
doi: 10.1186/s12913-019-4067-4.

Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings?

Liora Shmueli  1 , Nadav Davidovitch  1 , Joseph S Pliskin  1   2 , Igal Hekselman  3   4 , Ran D Balicer  5 , Geva Greenfield  6
Affiliations
Comparative Study

Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings?

Liora Shmueli et al. BMC Health Serv Res. .

Abstract

Background: In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system.

Methods: A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model.

Results: 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others.

Conclusions: The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.

Keywords: Health policy; Inequalities; Private system; Public system; Second opinion; Utilization.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol study was approved by the sub Institutional Helsinki committee at “MEIR” Medical Center, for non-clinical studies (Approval K2010/137).

A verbal informed consent was obtained from all participants. The study method was a telephone survey, and a verbal consent was obtained at the beginning of the telephone interview.

Consent for publication

Not applicable.

Competing interests

All authors listed have contributed sufficiently to the project to be included as authors, and meet each of the three authorship requirements as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (www.icmje.org).

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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