Abstract
BackgroundIn 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.MethodsA 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.Results214 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.ConclusionsThe 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.
Highlights
In most countries, patients can get a second opinion (SO) through public or private healthcare systems
Differences in utilization of second opinions in the private vs public systems In our final model we found that immigrants tend to seek more SOs from the public system compared to the private one
The study analyzed the characteristics of people seeking a SO from the public system vs. the private system
Summary
Patients can get a second opinion (SO) through public or private healthcare systems. Socio-economic status, education, income and occupation are well known factors intertwined with health behaviors and. These inequalities are more obvious in countries where healthcare services are mostly privatized, they exists in national tax-funded healthcare systems [7]. There are differences among countries in access, provision and payment mechanisms for SOs. In a private market such as in the US, health insurance plans may require and provide mandatory SOs for surgery. In countries that has a National Health Insurance (NHI) such as Canada, there is no mandatory SO requirement before surgery [23]
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