Targeted case-management, second surgical opinion
, and ambulatory surgery programs were seen as having only modest positive effects on costs.
There is much to surprise the interested reader: for instance, a fact not well known to those who teach health economics is that the incidence of mandatory second surgical opinion
has fallen recently in the private sector, but has risen in the state and local government sector.
Other changes in health care benefits for active employees included up to 30 out-patient visits for mental health treatment, with reimbursement ranging from 90 percent for the first 10 sessions to 70 percent for the last 10 sessions; a $500 annual maximum for chiropractic services; a $400 annual maximum for hearing devices purchased from a non-network provider; a requirement for a second surgical opinion
, with reimbursement ranging from 90 percent for an inarea provider to 60 percent for an out-of-area provider; and for employees under a health maintenance organization (HMO) plan, the establishment of a prescription drug plan similar to the network coverage and the imposition of a $5 employee copayment for doctors' office visits.
* Second surgical opinion
(SSO) is another service designed to influence employees' choice of treatment.
You do not have to pay the deductible and coinsurance if Medicare's Peer Review Organization (PRO) requires you to get a second surgical opinion
. If the second opinion required by a PRO disagrees with the first opinion, you can get a third opinion without having to pay the deductible and consinsurance.
Two-thirds of the utilization review programs include a mandatory second surgical opinion
. Outpatient utilization review and voluntary second surgical opinion
were each mentioned by nearly 40 percent of the respondents.
The failure of various "supply-side" efforts to manage costs, whether through precertification, second surgical opinion
, peer review, or certificate of need, mandates that providers now attempt to affect the "demand" side of the healthcare equation.
(6) Data on second surgical opinion
provisions represents health care participants enrolled in plans other than Health Maintenance Organizations (HMO'S) because HMO'S do not offer outpatient surgery incentives.
Second surgical opinion
(SSO) programs were one of the first cost containment strategies used by employers to control unnecessary treatment.
Other changes in the health care plan (most of which are effective January 1, 1991) include the requirement for a second surgical opinion
for certain surgical procedures; a newly established copayment of $3 for generic drugs and $7 for brandname drugs; preventive mammography screening; payment of outpatient psychiatric care at 60 percent of reasonable and customary costs; payment at 80 percent for certain other outpatient sevices, such as pre-admission testing and second surgical opinions
; improvements in dental coverage; and various changes to post-retirement health care benefits.
(See table 1.) For example, 35 percent of the private sector participants were required to seek a second surgical opinion
, compared with 23 percent of participants in the public sector.
There has been a number of legislative mandates passed that has expanded benefits for things other than parity, including maternity benefits, second surgical opinion
, and others.