Abstract
Purpose: Second-opinions (SOs) are a main expenditure of the health-funds’ supplementary insurance programs in Israel. A legislation in 2016 abolished the option of “reimbursement” for SOs provided by independent surgeons and limits these services to surgeons who are under contract with the supplementary insurance by paying a “direct co-payment”. We aim to analyse second-opinion utilization by payment method: “reimbursement” and “direct-co-payment” prior
and after this policy regulation, considering patient and specialist characteristics and to evaluate inequalities in accessibility across geographical areas by these payment methods.
Method(s): We applied an electronic medical records analysis (2011-2017, 1.4 million patients each year), We predicted the characteristics of patients and specialists by their payment method using multivariate logistic regressions.
Result(s): Patients from the Arab sector, from 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 the center of the country, the number of active specialists increased (2001 to 2017) at nearly the same rate as the demand of patients seeking SOs by direct-co-payment, while in the periphery the number of active specialists did not increase at the same rate as the demand of patients seeking SOs by direct-co-payment. Half of the physicians who provided SOs were surgeons whose clinics were based in central residential areas, while only 7% of the physician clinics were based in peripheral areas.
Conclusion(s): In peripheral areas the number of active specialists did not increase at the same rate as the demand of patients seeking SOs by direct-co-payment compared with central areas. This may suggest inequality in the supply of physicians in the arrangement in peripheral areas, hence it is proposed to increase accessibility of consultant physicians providing SOs in
peripheral areas.
and after this policy regulation, considering patient and specialist characteristics and to evaluate inequalities in accessibility across geographical areas by these payment methods.
Method(s): We applied an electronic medical records analysis (2011-2017, 1.4 million patients each year), We predicted the characteristics of patients and specialists by their payment method using multivariate logistic regressions.
Result(s): Patients from the Arab sector, from 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 the center of the country, the number of active specialists increased (2001 to 2017) at nearly the same rate as the demand of patients seeking SOs by direct-co-payment, while in the periphery the number of active specialists did not increase at the same rate as the demand of patients seeking SOs by direct-co-payment. Half of the physicians who provided SOs were surgeons whose clinics were based in central residential areas, while only 7% of the physician clinics were based in peripheral areas.
Conclusion(s): In peripheral areas the number of active specialists did not increase at the same rate as the demand of patients seeking SOs by direct-co-payment compared with central areas. This may suggest inequality in the supply of physicians in the arrangement in peripheral areas, hence it is proposed to increase accessibility of consultant physicians providing SOs in
peripheral areas.
| Original language | English |
|---|---|
| Pages (from-to) | E440-E440 |
| Journal | Medical Decision Making |
| Volume | 40 |
| Issue number | 5 |
| DOIs | |
| State | Published - Jul 2020 |