Utilization of second medical opinions as a function of the payment method

Background: The cost of a medical service and its mode of payment are known to play a role in patient decision-making, as demonstrated by the pioneering RAND Corporation Health Insurance Experiment (HIE). This study explores second medical opinion (SO) utilization by payment tracks- “financial reimbursement track” and “network track” by holders of an optional supplementary health insurance. It estimates SO utilization patterns before and after a “Reimbursement-to-Networks Arrangement” regulatory reform initiated on 2015 that eliminated the reimbursement option for SO consultations specifically involving surgeons, and identifies demographic and clinical predictors associated with each payment track before the reform. Methods: Retrospective analysis of medical records data, including secondary care visits data from Clalit Health Services, Israel’s largest healthcare provider, and claims data from Clalit’s supplementary insurance. An algorithm based on data from Clalit’s electronic medical records was used to identify SO instances by payment method. Multivariate logistic regression was used to identify characteristics of SO seekers by their payment method. Results: There was an increase of 28% in patient demand for SO consultations via the supplementary insurance's co-payment track from 2015 to 2017 due to the regulatory reform initiated in 2015. Before this reform, patients from the Arab sector, low socio-economic groups, immigrants, and residents of central geographical areas tended to seek SO via the “network track”. Whereas patients from peripheral areas and Jewish Orthodox tended to seek SOs via the financial reimbursement track. Conclusions: In line with the RAND Corporation HIE, we show that incentive structures, such as provider payment methods, can explain some of the variability seen in seeking specialists across health plans or payment tracks. Considerations other than cost, such as geographic distance from the service provider, play a role in deciding on the mode-of-payment for a SO. Analyzing utilization patterns can improve the tracking of regulations’ consequences on expenditure, policy, clinical outcomes, and patient satisfaction.