The Effect of a Mandatory Second Opinion Program on Medicaid Surgery Rates - An Analysis of the Massachusetts Consultation Program for Elective Surgery

摘要

This study examines the first year impact of a mandatory second surgical opinion for Medicaid enrollees in the State of Massachusetts. Enacted by the Massachusetts State Legislature in 1976, the program requires all Medicaid beneficiaries recommended for any one of eight designated elective procedures to get a second opinion before undergoing surgery. Although obtaining the second opinion, patients were free to decide whether to have surgery regardless of the consultants advice. The procedures covered were tonsillectomy/adenoidectomy, menisectomy, hysterectomy, cholecystectomy, submucuous resection, spinal fusion/disc surgery, hemorrhoidectomy, and excision of varicose veins. The report indicates that the program resulted in a 20% decline in surgery rates for the eight procedures in the year following program implementation. After accounting for alternate medical and surgical treatment, the estimated net cost benefit ratio was 1:3:9. The surgery decline was in part due to a sentinel effect--that is physicians proposed less surgery--and in part to patient's decisions based on the second and, in some cases, a third opinion.