[Second opinion--from the medical insurance viewpoint]

The history of the initial second opinion programmes is summarized. The original expectations in these programmes and their goals are stated. Some studies on second opinion programmes showed cost-savings in health care expenditure. However, there are no valid studies proving that the health care budget had been decreased. Improvements in the patient doctor relationship were demonstrated although improvements in the quality of patient care through second opinion programmes could not be ascertained. This lack of consistency reflects the limited reliability of clinical judgements. J. R. Clarke demonstrated that analysing the decision path leading to a surgical procedure was superior to second opinion programmes in achieving a correct surgical therapy. The Swiss Accident Insurance Company (SUVA) is organized in regionally assigned physicians and a dense network of administrative offices providing proficient advisory (support?) services to physicians in practice. Additional programmes are therefore not advocated and a mandatory confirmation of the need for certain surgical indications through second opinion programmes is not required. Instead, we advise to employ decision analysis in order to strengthen the foundation of clinical judgments and to improve the selection of therapies. It is proposed that elaborating medical-surgical decision paths should include psychological, socio-economical and cultural issues affecting the patient's welfare, in addition to anatomical and technical aspects determining the therapeutic feasibility.