Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: A population-based study

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. Design An observational study. Setting Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. Participants The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. Outcomes measures An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. Results 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). Conclusions Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.

Original languageEnglish
Article numbere025673
JournalBMJ Open
Issue number7
StatePublished - 1 Jul 2019


  • public health fund
  • second medical opinion
  • supplementary healthcare insurance


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