Imperial College London


Faculty of MedicineSchool of Public Health

Research Fellow in Public Health



+44 (0)20 7594 8595g.greenfield Website




314Reynolds BuildingCharing Cross Campus






BibTex format

author = {Greenfield, G},
doi = {10.1136/bmjopen-2018-025673},
journal = {BMJ Open},
pages = {1--10},
title = {Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study},
url = {},
volume = {9},
year = {2019}

RIS format (EndNote, RefMan)

AB - Objectives: To evaluate the utilization (overall and by specialty) and the characteristics ofsecond-opinion seekers by insurance type (either health-fund or supplementary insurance) ina mixed private-public healthcare.Design: An observational study.Setting: Secondary care visits provided by a large public health-fund and a largesupplementary health insurance in Israel.Participants: The entire sample included 1,392,907 patients age 21 and above who visited atleast one specialist over an 18-months period, either in the secondary care or privately via thesupplementary insurance.Outcomes measures: An algorithm was developed to identify potential second-opinioninstances in the dataset using visits and claims data. Multivariate logistic regression was usedto identify characteristics of second-opinion seekers by the type of insurance they utilized.Results: 143,371 (13%) out of 1,080,892 patients who had supplementary insurance sought asingle second-opinion, mostly from orthopedic surgeons. Relatively to patients who soughtsecond-opinion via the supplementary insurance, second-opinion seekers via the health-fundtended to be females (OR=1.2, 95% CI 1.17–1.23), of age 40-59 (OR= 1.36, 95% CI 1.31–1.42) and with chronic conditions (OR=1.13, 95% CI 1.08–1.18). In contrast, second-opinionseekers via the supplementary insurance tended to be native-born and established immigrants(OR=0.79, 95% CI 0.76–0.84), in a high socio-economic level (OR= 0.39, 95% CI 0.37–0. 4)and living in central areas (OR= 0.88, 95% CI 0.85–0.9).Conclusions: Certain patient profiles tended to seek second-opinions via the supplementaryinsurance more than others. People from the center of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas.
AU - Greenfield,G
DO - 10.1136/bmjopen-2018-025673
EP - 10
PY - 2019///
SN - 2044-6055
SP - 1
TI - Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study
T2 - BMJ Open
UR -
UR -
UR -
VL - 9
ER -