Analysis of second opinion programs provided by German statutory and private health insurance – a survey of statutory and private health insurers

Abstract

Background Second medical opinions can give patients confidence when choosing among treatment options and help them understand their diagnosis. Health insurers in several countries, including Germany, offer formal second opinion programs (SecOPs). We systematically collected and analyzed information on German health insurers’ approach to SecOPs, how the SecOPs are structured, and to what extent they are evaluated. Methods In April 2019, we sent a questionnaire by post to all German statutory (n = 109) and private health insurers (n = 52). In September 2019, we contacted the nonresponders by email. The results were analyzed descriptively. They are presented overall and grouped by type of insurance (statutory/private health insurer). Results Thirty one of One hundred sixty one health insurers (response rate 19%) agreed to participate. The participating insurers covered approximately 40% of the statutory and 34% of the private health insured people. A total of 44 SecOPs were identified with a median of 1 SecOP (interquartile range (IQR) 1–2) offered by a health insurer. SecOPs were in place mainly for orthopedic (21/28 insurers with SecOPs; 75%) and oncologic indications (20/28; 71%). Indications were chosen principally based on their potential impact on a patient (22/28; 79%). The key qualification criterion for second opinion providers was their expertise (30/44 SecOPs; 68%). Second opinions were usually provided based on submitted documents only (21/44; 48%) or on direct contact between a patient and a doctor (20/44; 45%). They were delivered after a median of 9 days (IQR 5–15). A median of 31 (IQR 7–85) insured persons per year used SecOPs. Only 12 of 44 SecOPs were confirmed to have conducted a formal evaluation process (27%) or, if not, plan such a process in the future (10/22; 45%). Conclusion Health insurers’ SecOPs focus on orthopedic and oncologic indications and are based on submitted documents or on direct patient-physician contact. The formal evaluation of SecOPs needs to be expanded and the results should be published. This can allow the evaluation of the impact of SecOPs on insured persons’ health status and satisfaction, as well as on the number of interventions performed. Our results should be interpreted with caution due to the low participation rate.

Attitude toward second opinions in Germany – a survey of the general population

“…Around 70% of participants would consider it (very) important that the second opinion provider can perform further treatment. This is contrary not only to many SO programs offered by health insurers [ 16 ] and to the SO Directive but also to the fact that independence was rated as (very) important by many participants. Perhaps the participants’ understanding of independence was different to ours.…”

“…This may have raised awareness and created a certain degree of public mistrust. Perhaps as a result, orthopedic SOs are common [ 10 , 16 , 17 ]. Furthermore, the numbers may reflect the prevalence of the indications.…”

“…However, 80% of participants rated the access a physician providing the SO has to a network of experts as (very) important. This is only part of the SO Directive for a subset of indications but it is part of some SO programs provided by health insurers [ 16 ]. Around 70% of participants would consider it (very) important that the second opinion provider can perform further treatment.…”

“…Many statutory health insurers provide (telemedical) SO programs [ 15 ]. These SO programs are often provided based on documents only and often exclude direct and personal contact between patients and physicians [ 16 ]. Even though high patient satisfaction was found for customers of an online portal providing SOs based on documents only [ 17 ], a survey of the general population in Germany found that 90% preferred personally delivered SOs [ 10 ].…”

Second Opinions for Spine Surgery: A Scoping Review

“…Those initiated by doctors and health insurers may have different drivers; they may be related to reducing the provision of low-value care (i.e., care that provides little or no bene t, may cause harm, or yields marginal bene ts at a disproportionately high cost). 4 In Australia, some private health insurers currently have second opinion services, typically offered by thirdparties separate to the insurer. 5,6 Musculoskeletal conditions are amongst the most common reasons why people seek a second opinion.…”