A representative from a health insurance provider offers his views on second opinions “An interdisciplinary point of view is helpful“
“Obtaining a second opinion is basically always a good thing,” says Guido Dressel , Director of the Techniker Krankenkasse (TK) health insurance company in the German state of Thuringia. In the following interview, Dressel describes the important things to consider when choosing a physician for a second opinion
Mr. Dressel, TK now enables second opinions to be obtained within the framework of voluntary selective contracts – for example, in cases where spinal surgery is considered necessary. What exactly do you offer your policyholders in such situations?
Guido Dressel: According to a survey conducted by Forsa on behalf of TK in the summer of 2015, 75 percent of all statutory health insurance policyholders wish to be able to obtain an independent second opinion prior to a planned hospital stay. We support this desire in three different ways. First of all , we allow such patients to obtain the information they need. According to Section 76 of the German Social Security Code (SGB V), every statutory health insurance policyholder has the right to consult a second physician in order to obtain additional information on their illness or learn about possibilities for alternative treatments. The new Care Provision Strengthening Act also includes a provision for a regulated process for obtaining second opinions.
In addition, TK policyholders can call the TK Second Opinion Hotline, which is staffed by all different kinds of doctors, mainly orthopedic specialists, oncologists, and surgeons. These professionals provide assistance and advice around the clock. The third way we support our policyholders is by offering them targeted assistance prior to hip, knee, shoulder, or spinal surgery. Here, we work with special centers that provide our customers with a second opinion prior to an operation. Alternatively, attending physicians can send patients to a pain therapy center specializing in their condition. Doctors at such centers can then determine whether inpatient surgery is actually necessary.
What has your experience been with second opinions?
Guido Dressel: The “Second Opinion Prior to Spinal Surgery” model project launched in 2010 has revealed that nearly 90 percent of all the back operations it examined were not necessary. Patients insured by TK can obtain a second opinion for free prior to a planned operation, and around 2,000 TK policyholders have elected to do so to date. As it turns out , the second-opinion physicians judged 1,800 of the planned operations to be unnecessary, and the patients were then treated with alternative methods, such as physiotherapy or pain therapy.
Which criteria should be used when choosing a physician for a second opinion?
Guido Dressel: A second opinion is particularly effective when the doctor in question focuses on different aspects than the original attending physician. For example, physicians in private practice tend to approach things differently than specialists who work in hospitals. A doctor who regularly performs surgery will have a different point of view than a more conservative physician, who might also have training in physiotherapy or psychosomatic medicine, for example. In any case, an interdisciplinary point of view is helpful.
Many physicians in private practice tend to favor conservative treatments over surgery. How can health insurance companies take this into consideration when setting their budgets?
Guido Dressel: You’ve touched upon a fundamental health-policy problem that no single provider can solve on its own – namely the fact that from an economic point of view, it’s often more attractive these days to operate on patients than it is to offer them conservative treatment options. The elected bodies at the statutory health insurance companies need to act here, and a good start would be to promote the use of narrative-based medicine techniques. †
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