Martin S G, Shwartz M, Whalen B J, D'Arpa D, Ljung G M, Thorne J H, McKusick A E
Med Care. 1982 Jan;20(1):21-45. doi: 10.1097/00005650-198201000-00003.
The effect of the Massachusetts second-opinion program on the volume of elective surgery in the Medicaid population was assessed using two approaches: a study of the program experience and surgery decisions of 2,501 program referrals, and an analysis of Medicaid surgery rates before and after program implementation. Nonconfirmation rates, which averaged 14.5 per cent, varied by procedure from 4 per cent for cholecystectomy to 26 per cent for disc surgery. The patient's surgery decision was related to the outcome of the second-opinion consultation: 85.5 per cent of the confirmed patients had the originally proposed operation, as compared with 31 per cent of the nonconfirmed patients. In the year after program implementation, the program was associated with a 20 per cent reduction in the volume of those procedures covered by the program. The greatest percentage declines were for hysterectomies, meniscectomies, hemorrhoidectomies and tonsillectomies/adenoidectomies. The decline in surgery rates was attributed both to a direct effect on patients referred to the program and to a sentinel effect whereby fewer operations were proposed. We conclude that the mandatory second-opinion program in Massachusetts saved Medicaid $3 to $4 for every dollar spent.
一是对2501例项目转诊病例的项目经历及手术决策进行研究，二是对项目实施前后医疗补助手术率进行分析。不确认率平均为14.5%，因手术类型而异，胆囊切除术为4%，椎间盘手术为26%。患者的手术决策与第二诊疗意见咨询的结果相关：85.5%得到确认的患者接受了最初建议的手术，相比之下，未得到确认的患者中这一比例为31%。在项目实施后的一年里，该项目使项目所涵盖手术的手术量减少了20%。降幅最大的是子宫切除术、半月板切除术、痔切除术以及扁桃体切除术/腺样体切除术。手术率的下降既归因于对转诊至该项目的患者的直接影响，也归因于一种警示效应，即提议进行的手术减少了。我们得出结论，马萨诸塞州的强制性第二诊疗意见项目每花费1美元，就能为医疗补助节省3至4美元。
