Gertman P M, Stackpole D A, Levenson D K, Manuel B M, Brennan R J, Janko G M
N Engl J Med. 1980 May 22;302(21):1169-74. doi: 10.1056/NEJM198005223022103.
In 1977, Massachusetts implemented a requirement that Medicaid recipients obtain a second surgical opinion before elective surgery. Using consultants' reports and surveys, we assessed the initial year's results in metropolitan Boston. Of 2060 Medicaid patients originally advised to undergo one of eight elective surgical procedures, 1591 (77.2 per cent) participated in the mandatory second-opinion consultation program, 10.5 per cent received approval for surgery without a second opinion because of clear indications such as cancer, and 12.3 per cent did not keep or accept appointments for a second opinion. Of the 1591 patients who participated, 88.7 per cent were given second opinions in favor of surgery, and 11.3 per cent were advised against surgery. Eight-two of the 180 patients advised not to have surgery sought a third opinion; the negative second opinion was reversed by the third consultant in 57 of these cases (69.5 per cent). Thus, surgery was rejected by a second or third consultant for only 7.7 per cent of the participating patients. We conclude that many negative second opinions are due to honest disagreement about indications for surgery. We also estimate that although the second-opinion program may produce only modest direct savings in Medicaid expenditures, it probably offers important improvements in the quality of health care.
1977年，马萨诸塞州实施了一项要求，即医疗补助计划的受助者在接受择期手术前需获得第二种手术意见。我们利用咨询顾问的报告和调查，评估了大波士顿地区第一年的结果。在最初被建议接受八种择期手术之一的2060名医疗补助患者中，1591名（77.2%）参与了强制性的第二种意见咨询计划，10.5%的患者因癌症等明确指征在未获得第二种意见的情况下获得了手术批准，12.3%的患者未保留或接受第二种意见的预约。在参与的1591名患者中，88.7%的患者获得了支持手术的第二种意见，11.3%的患者被建议不要进行手术。在180名被建议不要进行手术的患者中，有82名寻求了第三种意见；在这些病例中，57例（69.5%）的第三位咨询顾问推翻了否定的第二种意见。因此，只有7.7%的参与患者被第二位或第三位咨询顾问拒绝手术。我们得出结论，许多否定的第二种意见是由于对手术指征存在诚实的分歧。我们还估计，虽然第二种意见计划可能只会在医疗补助支出上产生适度的直接节省，但它可能会在医疗保健质量方面带来重要改善。
