Ruchlin H S, Finkel M L, McCarthy E G
Med Care. 1982 Jan;20(1):3-20. doi: 10.1097/00005650-198201000-00002.
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.
本研究评估了一项代表大型塔夫脱-哈特利福利基金实施的强制二次会诊计划，该福利基金为12万名受益人和受抚养人提供医疗保健覆盖。在为期两年的接收期（1977年至1978年）内，2284人就首诊医生或外科医生推荐的择期手术接受了二次会诊。在这一组中，366人被告知其不需要手术。该组中有342人的医疗理赔数据可用，这些数据构成了当前分析的基础。随机选择了数量相当的得到肯定确认的个体作为对照组，用于估计该计划节省的费用。两组均从会诊之日起随访一年。该计划总共节省了534791美元。其中，医疗保健利用节省了361756美元，生产力节省了173035美元。该计划的成本为203300美元，效益成本比为2.63。这些发现表明，以消费者为导向且在提供医疗服务之前进行干预的强制二次会诊计划显然具有成本效益。
