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A PROPOSAL TO INVESTIGATE THE IMPACT OF THE

SECOND SURGICAL OPINION REQUIREMENT

Approximately 60 percent of the American population is covered by private health care insurance programs (Congressional Budget Office, 1989). Most of these programsthe very great majorityare either fully or partly funded by employers, while the remainder are funded fully by the covered individuals and families. For the remaining 40 percent of the population, the delivery of health care services is either (1) funded by the federal government (for approximately 25 percent of the population, primarily through the Medicaid program), or by individuals and families in the financial position to pay for health care services at the time of delivery, or (2) deferred. When all is said and done, approximately 12 percent of the country's population is without any formal health care insurance coverage, and is not in a financial position to fund such services as required.

The proposed research is concerned with the approximately 60 million persons who receive Medicaid funded health care services. Medicaid, however, must also be prepared to deal with the approximately 30 million persons who are without any formal health care insurance coverage, and are not in a financial position to fund such services as required. The working poor

without health care insurance tend to postpone medical consultation and treatment, to avoid incurring costs they cannot afford. As a consequence, when they do receive health care services, those services are typically more extensive and more costly than would have been the case, had consultation and treatment been sought earlier. The higher cost of these deferred services often results in charges to the Medicaid program.

Seemingly countless numbers of techniques have been proposed, and many have been implemented by the federal government and private insurers in an effort to control the costs associated with the...