You might say: “I live in a major Western city – maybe London, Berlin, or New York – I have а great health insurance and there are plenty of specialists in hospitals nearby. Why do I need an independent second opinion for a medical problem or question I have?”
There are at least three reasons why you need our services:
The hospital you walk into is a business primarily interested in getting potentially hundreds of thousands of dollars from your insurance, or from the government – if the state pays for your healthcare.
This hospital is not interested in finding you the best possible specialist anywhere – an expert who perfectly fits your specific condition.
There is no incentive for any hospital or clinic you walk into with any medical problem to find a specialist for you outside that particular hospital, even in situations where they know that a specialist with a better fit for your situation exists elsewhere.
“We have all the best specialists” – is the answer you will hear. This may or may not be true.
The goal of any hospital is to capture as much business from you as possible.
This applies whether the state pays for your care in Western Europe or Canada or if you have a private insurance in the US or another country.
Private insurance often pays more, hence patients with private insurance – to use air travel analogy – are “business class passengers”. But you are still confined to one “airline” [hospital], even though other “carriers” might have a better deal for you: your “flight time might be shorter, connections fewer, and experience more pleasant” [e.g., more knowledgeable surgeon works faster and has fewer complications] – to continue with “air travel” analogy for healthcare.
It is possible, even statistically likely, that other specialists in your province, your country, or even a 10-hour flight away (air travel is cheap today, at least compared to healthcare costs) might be a much better fit for your particular medical situation. Getting their unbiased independent opinion, or even possibly being treated by them, might save you recovery time, decrease risks of serious complications and improve your function.
You might save a lot of money and time by getting – on the first try – the right diagnosis and having the best specialist diagnose and treat you.
Every hospital wants to attract as many referrals as possible, whether or not this hospital or clinic truly is the best fit to treat a particular patient referred to it.
If this were not true, then all major hospital chains around the world would not be buying up physician practices in geographical areas they operate in. But they buy smaller hospitals and physician group practices in their “catchment areas” – to generate “captive referral networks” for themselves and to increase their revenue.
The biggest hospital in your area probably owns your doctor’s primary practice and most outpatient specialist physician groups around. Or it has contracts in place to make sure all referrals go to it and to nowhere else. Captive referral networks are a medical equivalent of industrial conveyor belt that reliably moves widgets along a predetermined path.
But you are not a widget – your situation is unique and solving it requires a unique approach by the best-fitting expert. Problem is a lock and expert is a key. They have to fit each other perfectly to open the door back to health.
Medical problem is a lock, and expert is a key. Get the best key!
If the state pays for your healthcare, you have almost no power to determine your own path within a healthcare system.
Should you care about having a free choice of the best physician who fits best your specific situation? You certainly should, because if you cannot choose the best doctor – you are not a customer.
And if you are not a customer, you are a product.
This is true even when the life of the patient is at stake. There is a lot of psychology involved, but business decisions matter too.
However, best doctors do recommend patients to get at least one, and sometimes two independent second opinions:
It is also a well-known fact that insurance companies enforce “gag rules” that prevent doctors to discuss with patients certain, potentially more effective, even if more expensive, treatments.
Similarly, physicians might have a preference for a certain way of treatment.
It is well known that “regional biases” often exist for methods of treatment of any medical condition within a given geographical area, or even in the entire given country. Such “preferred treatment methods” may not be the best ones for some patients. But when regional biases for certain treatment exist, they are surprisingly persistent at any given hospital group, region or country.
…Or doctors might sense that their knowledge and skills to use a particular method of treatment, which might be more advantageous for this particular patient, are limited. But they do not want to expose themselves to reputational risks if the diagnosis they offered proves incorrect or treatment methods they suggest are not the most appropriate for a particular patient.
In practice, most companies that offer second opinion services or medical consultations have conflicts of interest that stem from how their business is set up.
These companies mostly belong to one of three groups:
Such companies offer “second opinions” from specific hospitals in a particular country or region. Their primary goal is to bring business to their hospital employers or partners – they receive a commission fee for every patient they bring to their affiliated hospital.
If it is a tourist agency, it tries to compensate for decreasing tourist bookings via agencies by serving a “niche” of “medical tourism”. But such company has absolutely ZERO expertise or interest in the medical side of solving the problems of its clients. It generates income from travel bookings and from commissions kicked back from its affiliated hospitals.
These companies will always claim that their hospitals have the best specialist care you need. In reality, this could be the most expensive AND medically suboptimal solution for you.
For example, one of our clients required cancer surgery. One Western European hospital quoted the price of EUR 70,000, whereas a more suitable specialist for this type of surgery from a hospital not far from the first one quoted EUR 20,000 – over 3 times less for the same procedure. That’s a big difference for the patient, isn’t it?
These are often venture capital-funded firms that collect monthly subscription fees from employers for each enrolled employee. In return, they agree to provide second opinion services free of charge for employees of their client employer, whenever surgery may be recommended or serious health problems are discovered.
They directly advertise themselves to employers as a cost-cutting service for their health expenditures. Their goal is to save your employer or insurance company money by advising you to use more “conservative” or less costly treatments.
Again, such treatments may or may not be optimal for your situation.
Interestingly, their price for a “retail” second opinion, which is paid for by the client, is set at a level we consider prohibitively expensive for most people, for example, at USD 7,500 for one-physician second opinion.
Such prices reflect two realities that have nothing to do with the quality of advice patients receive:
First, such companies have large overhead costs, as they are geared towards serving employers, not employees or private clients.
Second, they are funded by venture capital firms that demand very high rates of return on their investments – which leads to price gouging their clients.
But what is more dangerous for clients of these employer-focused firms is that such companies have a fixed roster of doctors they use for providing second opinions.
Even though these doctors might work at well-known institutions, they understand very well what advice makes financial sense for the company they work for – and who is the ultimate payor of their fees. It is your employer that pays these consulting doctors through a subscription fee for each employee – you.
The motivation of your employer is first and foremost to cut the costs of your health care bill. Therefore, all second opinions prepared by doctors whose fees are paid by your employer cannot be considered truly independent from a financial incentive point of view.
If these doctors do not generate “savings” for your employer, they will likely be kicked off the company’s roster of providers and will lose their income stream from providing second opinion services.
This is a conflict of interest that does not serve your interests well.
It may seem counter-intuitive at first, but patients who get second opinions directly from a specific hospital face several limitations, including:
Limitation 1: You might not have a choice of selecting the specific physician who provides your second opinion.
What happens to your application after you hit the “submit” button is not transparent. Cases could be routed not to the most suitable specialist for your situation, but to those in a general specialty area who broadly match the area of your diagnosis, and who agree to do remote second opinions internally. They may or may not be the most suitable specialists to review your particular case.
Limitation 2: There is a conflict of interest for any given hospital to provide a second opinion.
Any hospital’s ultimate goal is to capture as much business from patients as possible. Hospital fees for diagnostic and treatment services exceed second opinion fees by 10 to 100 times. Which service makes most sense for a hospital then? So second opinion service by a given hospital serves first and foremost as another sales channel – a gateway to generate diagnostics and treatment business for that hospital.
Limitation 3: Your choice of experts is limited to that hospital’s internal staff.
Any hospital that offers a second opinion service will not recommend anyone outside its staff even when much better outside expert exists for a given situation . By definition, that is likely to limit options for those who seek the best, unbiased expert opinion for any medical problem. Any given hospital’s experts might be very well qualified in general, but are they the best in the world for your particular situation?
We are free of any affiliations with hospital networks, insurance companies or employers. We don’t have conflicts of interest to serve you – you are the only source of our fees.