BMC Health Services Research
Volume 19, Issue 1, 2019

Reasons, perceived outcomes and characteristics of second-opinion seekers: Are there differences in private vs. public settings? (Article) (Open Access)

Shmueli L. , Davidovitch N. , Pliskin J.S. , Hekselman I. , Balicer R.D. , Greenfield G.*
  • a Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel
  • b Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel
  • c Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel, Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel
  • d Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, Bnei Brak, 5120149, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • e Clalit Research Institute, Clalit Health Services, 101 Arlozorov, Tel-Aviv, 62098, Israel
  • f Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London, W6 8RP, United Kingdom

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. © 2019 The Author(s).

Author Keywords

inequalities Utilization Public system Second opinion health policy Private system

Index Keywords

perception clinical outcome immigrant Israel health care policy human Israeli middle aged statistics and numerical data comparative study Aged Logistic Models Physicians private practice Cross-Sectional Studies Young Adult cross-sectional study Humans psychology Adolescent male female patient referral Socioeconomic Factors Referral and Consultation socioeconomics telephone interview income group patient satisfaction Article major clinical study private sector adult migration physician market patient attitude outcome assessment Emigration and Immigration Patient Acceptance of Health Care statistical model Delivery of Health Care public sector satisfaction health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064837219&doi=10.1186%2fs12913-019-4067-4&partnerID=40&md5=d144f89958ad8a9d914e8283a16ad597
DOI: 10.1186/s12913-019-4067-4
ISSN: 14726963
Cited by: 2
Original Language: English