The Efficacy of Second-Opinion Consultation Programs: A Cost???Benefit Perspective

This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120, 000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2, 284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at 534, 791. Of this amount, medical care utilization savings were 361, 756 and productivity savings were 173, 035. The cost of the program was 203, 300, yielding a benefit-cost ratio of 2. 63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.