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A literature review of second opinion and public health information

กานต์ สุวรรณสาครกุล; อนุพงษ์ วิเลปนานนท์;
Date: 2549-03
Abstract
Second Opinions is one of the efficient medical procedures to enhance quality and reliability of health care system, particularly from the patient’s point of view. To be applied in Thailand, this will provide evidence of our patient’s rights enhancement as well as consumer empowerment, in terms of allowing consumers to receive better quality of health care services. The objective of this study is to review the literatures related to Second Opinions and people’s access to public health information, with the aim to find out preliminary information required for a proper development of Second Opinions System in Thailand. From the literature review, Second Opinions has been initiated and implemented formally in the USA since 1970s. Initially, Second Opinions was used as a utilization review technique to reduce unnecessary costs associated with overused and inappropriate surgeries rather than used as an approach to offer additional information or other further medical opinions to patients. Nowadays, in most countries, Second Opinions is adopted and used based on the same common principle, which regards Second Opinions as a fundamental right of patients to get reassurance, additional information, as well as other treatment options from health care service providers, except in the USA where the importance is also given to cost benefits obtained from implementing the program. It can be seen that, in practices, there are differences in intensity and scope of regulation imposed regarding the application of Second Opinions among the studied countries. Some countries have published state laws regulations to support the implementation of Second Opinions program. On the other hand, some countries see Second Opinions as a typical issue in medical ethics that every practitioner needs to follow, thus no need to use law enforcement. The methods of obtaining Second Opinions in the studied countries are similar among each other, but the number of usage and effectiveness of each method are varied according to various fundamental factors in each country such as education level of population, technology development, state regulations, and local cultures. In the present, Thailand has the declaration of patient’s rights as the main mechanism to move forwards to the establishment of Second Opinions System. However, other supporting mechanisms still need to be developed in order to ensure the system effectiveness. The Second Opinions adopted for Thailand should be on a voluntary basis, giving focus to the patient’s right to make decision, rather than on a mandatory basis. Under this voluntary basis, patients will have an automatic right to request second opinion directly from their attending doctors. The recommended framework for the development of Second Opinions System are as following 1) Driving: using laws/regulations, documented medical ethics, and public relation to strive for public awareness; 2) Implement & Control: related public health assurance units should be assigned to oversee the implementation as well as control the costs incurred from operating the program; 3) Support: the proper development of public health information system and coordination units/centers would provide supporting infrastructure to the adopted system. Under this framework, there are numbers of involved activities such as regulation amendments, public relation, database set-up, further study on cost, etc. Then, after the system has been established, concerned government agencies should relay information to the public through the effective public relation program and then continually follow-up the implementation closely in order to evaluate its effectiveness and eliminate the problems occurred. Although, this report gives preliminary ideas and information required for a development of Second Opinions System in Thailand, many further studies also need to be conducted to give full details of pro’s and con’s of having such system prior to making a go/no-go decision.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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