The evaluation and monitoring of a Medicaid second surgical opinion program

The evaluation of newly implemented and controversial programs often present real problems for the evaluator. When a program is accompanied by a legislatively mandated evaluation, the issues become even more acute. The evaluator, wanting to impact on policy, must strike a balance between the adherence to principles of scientific inquiry, yet be responsive to the needs of policymakers. This paper describes the evaluation and follow-up monitoring of a recently established second opinion program for Medicaid recipients. The program was to terminate in 17 months unless extended by the Wisconsin Legislature. The evaluation found, among other things, marked reductions in the use of surgical services after implementation of the second opinion program. Based in large part on the evaluation, the program was extended with a provision for continued monitoring. The paper discusses the factors that contributed to the evaluation having a major impact on the decision to extend the program.