Top

BMC Health Services Research

Published in:

Open Access 01-12-2019 | Research article

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

Authors: Liora Shmueli, Nadav Davidovitch, Joseph S. Pliskin, Igal Hekselman, Ran D. Balicer, Geva Greenfield

Published in: BMC Health Services Research | Issue 1/2019

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.

Ferguson JAWM. Racial disparity in cardiac decision making: results from patient focus groups. Arch Intern Med. 1998;158:1450–3. https://doi.org/10.1001/archinte.158.13.1450.CrossRefPubMed

Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x.CrossRefPubMedPubMedCentral

Stringhini S, Sabia S, Shipley M, et al. ASsociation of socioeconomic position with health behaviors and mortality. JAMA. 2010;303:1159–66. https://doi.org/10.1001/jama.2010.297.CrossRefPubMedPubMedCentral

Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ. 2002;80:97–105. https://doi.org/10.1590/S0042-96862002000200004.CrossRefPubMedPubMedCentral

Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff. 2002;21:60–76. https://doi.org/10.1377/hlthaff.21.2.60.CrossRef

Bleich SN, Jarlenski MP, Bell CN, LaVeist TA. Health inequalities: trends, Progress, and policy. Annu Rev Public Health. 2012;33:7–40. https://doi.org/10.1146/annurev-publhealth-031811-124658.CrossRefPubMedPubMedCentral

Filc D, Davidovich N, Novack L, Balicer RD. Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health. 2014;13:115. https://doi.org/10.1186/s12939-014-0115-1.CrossRefPubMedPubMedCentral

Chernichovsky D. The public-private mix in the modern health care system - concepts, issues, and policy options revisited. Working paper: National Bureau of Economic Research; 2000. http://www.nber.org/papers/w7881. Accessed 21 Nov 2013

Chernichovsky D. Reforms are needed to increase public funding and curb demand for private care in Israel’s health system. Health Aff. 2013;32:724–33. https://doi.org/10.1377/hlthaff.2012.0283.CrossRef

10.

Philip J, Gold M, Schwarz M, Komesaroff P. Second medical opinions: the views of oncology patients and their physicians. Support Care Cancer. 2010;18:1199–205. https://doi.org/10.1007/s00520-009-0742-z.CrossRefPubMed

11.

Sutherland LR, Verhoef MJ. Patients who seek a second opinion: are they different from the typical referral? J Clin Gastroenterol. 1989;11:308–13.CrossRef

12.

Tattersall MHN, Dear RF, Jansen J, Shepherd HL, Devine RJ, Horvath LG, et al. Second opinions in oncology: the experiences of patients attending the Sydney Cancer Centre. Med J Aust 2009;191:209–212. https://doi.org/10.5694/j.1326-5377.2009.tb02754.x.

13.

Moumjid N, Gafni A, Bremond A, Carrere MO. Seeking a second opinion: do patients need a second opinion when practice guidelines exist? Health Policy. 2007;80:43–50.CrossRef

14.

Oskay-Ozcelik G, Lehmacher W, Konsgen D, Christ H, Kaufmann M, Lichtenegger W, et al. Breast cancer patients’ expectations in respect of the physician-patient relationship and treatment management results of a survey of 617 patients. Ann Oncol. 2007;18:479–84.CrossRef

15.

Tam KF, Cheng DK, Ng TY, Ngan HY. The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients. Support Care Cancer. 2005;13:679–84.CrossRef

16.

Clauson J, Hsieh YC, Acharya S, Rademaker AW, Morrow M. Results of the Lynn Sage Second-Opinion Program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered. Cancer. 2002;94:889–94.CrossRef

17.

Goldman RE, Sullivan A, Back AL, Alexander SC, Matsuyama RK, Lee SJ. Patients’ reflections on communication in the second-opinion hematology-oncology consultation. Patient Educ Couns. 2009;76:44–50.CrossRef

18.

Greenfield G, Pliskin JS, Feder-Bubis P, Wientroub S, Davidovitch N. Patient-physician relationships in second opinion encounters - the physicians’ perspective. Soc Sci Med. 2012;75:1202–12.CrossRef

19.

Mellink WA, Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing JM. Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol. 2003;21:1492–7.CrossRef

20.

Sato T, Takeichi M, Hara T, Koizumi S. Second opinion behaviour among Japanese primary care patients. Br J Gen Pract. 1999;49:546–50 http://www.ncbi.nlm.nih.gov/pubmed/10621989. Accessed 7 Feb 2011.PubMedPubMedCentral

21.

van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy. 2001;6:195–201. https://doi.org/10.1258/1355819011927486.

22.

Wagner T, Wagner L. Who gets second opinions? Health Aff (Millwood). 1999;18:137–45. https://doi.org/10.1377/hlthaff.18.5.137.

23.

Ridic G, Gleason S, Ridic O. Comparisons of Health Care Systems in the United States, Germany and Canada. Mater Sociomed. 2012;24:112. https://doi.org/10.5455/msm.2012.24.112-120.CrossRefPubMedPubMedCentral

24.

Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst. 1999;91:1480–6. https://doi.org/10.1093/jnci/91.17.1480.

25.

Mossialos E, Wenzl M, Osborn R, Sarnak D. International Profiles of Health Care Systems. The Commonwealth Fund. 2015. https://www.commonwealthfund.org/publications/fund-reports/2016/jan/international-profiles-health-care-systems-2015.

26.

OECD. Health at a Glance: OECD Indicators, OECD Publishing. Paris: OECD; 2017. https://doi.org/10.1787/19991312.

27.

Greenfield G, Pliskin JS, Wientroub S, Davidovitch N. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study. Isr J Health Policy Res. 2012;1:30.CrossRef

28.

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. https://doi.org/10.1177/1355819616650470.CrossRefPubMed

29.

Israeli Ministry of Health IM of H. A public report on supplementary health programs of the Israeli Health Funds in 2014. 2015. http://www.health.gov.il/PublicationsFiles/shaban2014_03012016.pdf.

30.

Vashitz G, Davidovitch N, Pliskin JS. Second medical opinions. Harefuah. 2011;150:105–10, 207 http://www.ncbi.nlm.nih.gov/pubmed/22164936. Accessed 10 June 2012.PubMed

31.

Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, et al. Second Medical Opinion: Utilization Rates and Characteristics of Seekers in a General Population. Med Care. 2016;:1. https://doi.org/10.1097/MLR.0000000000000567.

32.

Shmueli L, Davidovitch N, Pliskin JS, Balicer RD, Hekselman I, Greenfield G. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Isr J Health Policy Res. 2017;6:67. https://doi.org/10.1186/s13584-017-0191-y.

33.

Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med. 2012;9:e1001244. https://doi.org/10.1371/journal.pmed.1001244.CrossRefPubMedPubMedCentral

34.

Jofre-Bonet M. Public health care and private insurance demand: the waiting time as a link. Health Care ManagSci. 2000;3:51–71. https://doi.org/10.1023/A:1019024903898.CrossRef

35.

Russell S. Treatment-seeking behaviour in urban Sri Lanka: trusting the state, trusting private providers. Soc Sci Med. 2005;61:1396–407. https://doi.org/10.1016/j.socscimed.2004.11.077.CrossRefPubMed

36.

Berendes S, Heywood P, Oliver S, Garner P. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med. 2011;8:e1000433. https://doi.org/10.1371/journal.pmed.1000433.CrossRefPubMedPubMedCentral

37.

Pongsupap Y, Lerberghe WV. Choosing between public and private or between hospital and primary care: responsiveness, patient-centredness and prescribing patterns in outpatient consultations in Bangkok. Tropical Med Int Health. 2006;11:81–9. https://doi.org/10.1111/j.1365-3156.2005.01532.x.CrossRef

38.

Davidovitch N, Filc D, Novack L, Balicer RD. Immigrating to a universal health care system: utilization of hospital services by immigrants in Israel. Health Place. 2013;20:13–8. https://doi.org/10.1016/j.healthplace.2012.11.005.CrossRefPubMed

39.

Regidor E, Martínez D, Calle ME, Astasio P, Ortega P, Domínguez V. Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Serv Res. 2008;8:183. https://doi.org/10.1186/1472-6963-8-183.CrossRefPubMedPubMedCentral

40.

Victoor A, Delnoij DM, Friele RD, Rademakers JJ. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res. 2012;12:272. https://doi.org/10.1186/1472-6963-12-272.CrossRefPubMedPubMedCentral

41.

Detsky AS. WHat patients really want from health care. JAMA. 2011;306:2500–1. https://doi.org/10.1001/jama.2011.1819.CrossRefPubMed

Title: Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings?
Authors: Liora Shmueli
Nadav Davidovitch
Joseph S. Pliskin
Igal Hekselman
Ran D. Balicer
Geva Greenfield
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-4067-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico

What do patients really want? An in-depth examination of patient experience in four Australian hospitals

Correction to: Amputation rates of the lower limb by amputation level – observational study using German national hospital discharge data from 2005 to 2015

Evaluation of a community of practice for speech-language pathologists in aphasia rehabilitation: a logic analysis

Physician and pharmacist satisfaction and clinical needs for the real-time medication surveillance program in South Korea

Research funding impact and priority setting – advancing universal access and quality healthcare research in Malaysia