Researchers: Joseph Pliskin¹, Tuvia Horev¹

Background: Second opinion (SO) is a main expenditure of the health-funds’ (HFs) supplementary insurance in Israel. It increases the utilization of private health services. A new legislation has canceled the option of “reimbursement” for patients who paid for SO provided by independent surgeons and limits these services to surgeons who are under contract with the supplementary insurance by paying a “direct-co-payment”. Analyzing and documenting the current situation will improve the ability to track the consequences of this policy.

Objectives: To analyze SO utilization by payment method: “reimbursement” and “direct-co-payment” and to identify factors affecting utilization and provision, to examine demand and supply of physicians and to evaluate inequalities inaccessibility by these payment methods.

Method: An electronic medical records analysis (years of 2011-2017) and a telephone survey with a representative sample of the general Israeli population asking people about their SO payment, willingness-to-pay etc.

Findings: 58% out of 316 patients having supplementary insurance in 2011 mentioned they would consider seeking a SO even if the direct-co-payment will increase from 100 to 200 NIS. In practice, although the direct-co-payment rate increased by 50% in the years of 2011-2016, there was an increase of 45% in the demand of patients for SO consultations via the supplementary insurance. Patients from the Arab sector, low socio-economic group, immigrants and from central geographical areas tended to seek SOs by paying a “direct-co-payment”. Patients from periphery areas tended to seek SOs through the “reimbursement” method. In 2011 as well as 2017 consultants with the academic title “professor”, physicians in a managerial position at a hospital and specialists with seniority of 26 years and above tended to provide SOs by the reimbursement method.

Conclusions: Patients from periphery areas tended to seek SOs by reimbursement method, despite the high co-payment. This may hint on inequality in the supply of physicians in the arrangement.

Recommendations: There is a need to improve access to SO consultants in periphery areas, in order to increase patients’ freedom of choice among SO providers.

Research end date: 03/2019