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Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study
  1. Liora Shmueli1,
  2. Erez Shmueli2,
  3. Joseph S Pliskin3,4,
  4. Ran D Balicer5,6,
  5. Nadav Davidovitch4,
  6. Igal Hekselman7,8,
  7. Geva Greenfield9
  1. 1 Department of Management, Bar Ilan University, Ramat Gan, Israel
  2. 2 Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
  3. 3 Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  4. 4 Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  5. 5 Epidemiology, Ben-Gurion University, Tel Aviv, Israel
  6. 6 Clalit Research Institute, Tel Aviv, Israel
  7. 7 Clalit Mushlam Health Insurance, Bnei Brak, Israel
  8. 8 Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  9. 9 Department of Primary Care & Public Health, Imperial College London, London, UK
  1. Correspondence to Dr Liora Shmueli; liora.jana{at}gmail.com

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.

  • second medical opinion
  • public health fund
  • supplementary healthcare insurance

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Footnotes

  • Contributors LS was involved with conception and design, data collection and analysis and drafted the manuscript. ES was involved with data collection and analysis (writing the algorithm code) and contributed to the methods in the manuscript. JSP was involved with acquisition of funding, conception and design, data collection and analysis and revising the manuscript. RDB was involved with conception and design, data collection and analysis and revising the manuscript. ND was involved with acquisition of funding, conception and design, data collection and analysis and revising the manuscript. IH was involved with conception and design, data collection and analysis and revising the manuscript. GG was involved with acquisition of funding, conception and design, data collection and analysis and drafted the manuscript. All authors read and approved the final manuscript.

  • Funding Funding was provided by a grant from the Israel National Institution for Health Policy and Health Service Research (NIHP) under grant number R/10/144. GG was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (NIHR CLAHRC NWL).

  • Disclaimer The Israel National Institution for Health Policy and Health Service Research had no role in the design and conduct of the study: collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Ethics approval The protocol study was approved by the Institutional Helsinki Committee at ‘MEIR’ Medical Center, for non-clinical studies (approval K2010/137).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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