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Observational Study
. 2019 Jul 27;9(7):e025673.
doi: 10.1136/bmjopen-2018-025673.

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

Liora Shmueli  1 , Erez Shmueli  2 , Joseph S Pliskin  3   4 , Ran D Balicer  5   6 , Nadav Davidovitch  4 , Igal Hekselman  7   8 , Geva Greenfield  9
Affiliations
Observational Study

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

Liora Shmueli et al. BMJ Open. .

Abstract

Objectives: To evaluate the utilisation (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 aged 21 years 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 used.

Results: 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic 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 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 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 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9).

Conclusions: Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.

Keywords: public health fund; second medical opinion; supplementary healthcare insurance.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A time-sensitive algorithm for identifying second-opinion consultations.
Figure 2
Figure 2
Study population: patients sought a second opinion by insurance type: health fund vs supplementary insurance.
See this image and copyright information in PMC

References

    1. Mackintosh M, Channon A, Karan A, et al. . What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet 2016;388:596–605. 10.1016/S0140-6736(16)00342-1 - DOI - PubMed
    1. Barlow J, Roehrich J, Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff 2013;32:146–54. 10.1377/hlthaff.2011.1223 - DOI - PubMed
    1. Filc D, Davidovitch N. Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades. J Health Serv Res Policy 2016;21:249–56. 10.1177/1355819616650470 - DOI - PubMed
    1. Balicer RD, Shadmi E, Lieberman N, et al. . Reducing health disparities: strategy planning and implementation in Israel’s largest health care organization. Health Serv Res 2011;46:1281–99. 10.1111/j.1475-6773.2011.01247.x - DOI - PMC - PubMed
    1. Aaron KF, Clancy CM. Improving quality and reducing disparities: toward a common pathway. JAMA 2003;289:1033–4. 10.1001/jama.289.8.1033 - DOI - PubMed

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