OBJECTIVES: Second-opinion is a main expenditure of the ‘health-funds’ supplementary insurance programs in Israel. A legislation in 2016 has canceled the option of “reimbursement” for second-opinion provided by independent surgeons and limits these services to surgeons who are under contract with the supplementary insurance by paying a “direct co-payment”. We aim to analyse the supply and demand patterns of second-opinion by payment method prior and during to this policy regulation, considering the characteristics of specialists and patients.

METHODS: We applied an electronic medical records analysis (years of 2011-2017, 1.4 million patients each year), We predicted the characteristics of specialists and patients by their payment method using multivariate logistic regressions.

RESULTS: There was an increase of 45% in the demand of patients for SO consultations by direct-co-payment in the years of 2011-2016, whereas there was a decline in the demand of patients for SO consultations by the reimbursement method from 2011 to 2015 (28% to 20%), even prior to the policy regulation. In the center of the country the number of active specialists by direct-co-payment increased at nearly the same pace as the population size, as opposed to the periphery. Patients from the Arab sector, low socio-economic group, immigrants and from central geographical areas tended to seek SOs by paying a “direct-co-payment”. Patients from periphery areas tended to seek SOs through the “reimbursement” method. In 2011 as well as 2017 consultants with the academic title “professor”, physicians in a managerial position at a hospital and specialists with seniority of 26 years and above tended to provide SOs by the reimbursement method.

CONCLUSIONS: Patients from periphery areas tended to seek SOs by reimbursement method, despite the high co-payment. This may hint on inequality in the supply of physicians in the arrangement.