Dataset Information

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

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.

SUBMITTER: Shmueli L

PROVIDER: S-EPMC6661653 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Shmueli Liora L Shmueli Erez E Pliskin Joseph S JS Balicer Ran D RD Davidovitch Nadav N Hekselman Igal I Greenfield Geva G

BMJ open 20190727 7

<h4>Objectives</h4>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.<h4>Design</h4>An observational study.<h4>Setting</h4>Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel.<h4>Participants</h4>The entire sample included 1 392 907 patients aged 21 years and above who visited at ...[more]

PMID: 31352409

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Project description:BackgroundSecond medical opinions can give patients confidence when choosing among treatment options and help them understand their diagnosis. Health insurers in several countries, including Germany, offer formal second opinion programs (SecOPs). We systematically collected and analyzed information on German health insurers' approach to SecOPs, how the SecOPs are structured, and to what extent they are evaluated.MethodsIn April 2019, we sent a questionnaire by post to all German statutory (n = 109) and private health insurers (n = 52). In September 2019, we contacted the nonresponders by email. The results were analyzed descriptively. They are presented overall and grouped by type of insurance (statutory/private health insurer).ResultsThirty one of One hundred sixty one health insurers (response rate 19%) agreed to participate. The participating insurers covered approximately 40% of the statutory and 34% of the private health insured people. A total of 44 SecOPs were identified with a median of 1 SecOP (interquartile range (IQR) 1-2) offered by a health insurer. SecOPs were in place mainly for orthopedic (21/28 insurers with SecOPs; 75%) and oncologic indications (20/28; 71%). Indications were chosen principally based on their potential impact on a patient (22/28; 79%). The key qualification criterion for second opinion providers was their expertise (30/44 SecOPs; 68%). Second opinions were usually provided based on submitted documents only (21/44; 48%) or on direct contact between a patient and a doctor (20/44; 45%). They were delivered after a median of 9 days (IQR 5-15). A median of 31 (IQR 7-85) insured persons per year used SecOPs. Only 12 of 44 SecOPs were confirmed to have conducted a formal evaluation process (27%) or, if not, plan such a process in the future (10/22; 45%).ConclusionHealth insurers' SecOPs focus on orthopedic and oncologic indications and are based on submitted documents or on direct patient-physician contact. The formal evaluation of SecOPs needs to be expanded and the results should be published. This can allow the evaluation of the impact of SecOPs on insured persons' health status and satisfaction, as well as on the number of interventions performed. Our results should be interpreted with caution due to the low participation rate.

Project description:ImportanceDespite broad public support for gun safety policies, minimal policy implementation has occurred.ObjectiveTo investigate factors that encourage greater private support for and public action on gun safety policy.Design, setting, and participantsThree studies were conducted: a public opinion survey (Study 1) was conducted from January 8 to 22, 2019, and 2 experiments (Studies 2 and 3) were conducted from August 27 to October 17, 2019, and April 15 to 21, 2020, respectively. Adults living in the US were eligible to participate in Studies 1 and 3. Students 18 years and older participating in a research experience program were eligible to participate in Study 2. Study 1 was administered online by Ipsos, a market research company. A nationally representative sample of 1000 US adults was obtained from Ipsos' online KnowledgePanel, of whom 508 completed the public opinion survey. For Study 2, which was conducted in a university laboratory, 354 participants were recruited from a university research pool, all of whom completed the study. Study 3 was administered online by the market research company YouGov, which identified 727 US gun owners from its opt-in panel, from which it constructed a census-matched sample of 400 participants.ExposuresParticipants read a statement about the 2018 Marjory Stoneman Douglas High School shooting. Content was manipulated as a 2 (corrective information vs no corrective information) × 2 (system changeable vs system not changeable) between-subjects factorial design with random assignment. The corrective information included polling data highlighting widespread support among gun owners for several gun safety policies. System changeable described gun safety policies passed by Florida's legislature.Main outcomes and measuresMain outcomes were support for gun safety policies and public disclosure of support.ResultsThe 3 studies included a total of 1262 participants (Study 1: 508 participants; weighted mean [SD] age, 47.7 [17.5] years; 261.9 women [51.6%]; 82.5 Hispanic [16.2%] and 60.3 Black [11.9%]; Study 2: 354 participants; mean [SD] age, 20.0 [2.3] years; 232 women [65.9%]; 100 Asian [28.3%] and 37 Black [10.5%]; Study 3: 400 participants; weighted mean [SD] age, 52.1 [16.4] years; 187.3 women [46.8%]; 295.5 White [73.9%], 44.5 Hispanic [11.1%], and 32.4 Black [8.1%]). Study 1 found that 63% to 91% of gun owners and 83% to 93% of non-gun owners supported key gun safety policies, yet both groups significantly underestimated gun owners' support for these policies by between 12% and 31%. Studies 2 and 3 found that exposure to corrective information was associated with a small increase in support for 2 gun safety policies of between 4% and 15%, both in terms of participants' privately held beliefs and the beliefs they would be willing to share publicly.Conclusions and relevanceThis survey study found that many US adults failed to recognize that most gun owners support key gun safety policies. Correcting this misperception was associated with greater private and public support for gun safety policy.

Dataset Information

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

Objectives

Design

Setting

Participants

Outcomes measures

Results

Conclusions

Publications

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

Similar Datasets

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