| Verified against primary record | |
| Statutory entitlement, Germany | Before certain planned procedures, from a doctor other than the one proposing it, with the sickness fund paying[1] |
|---|---|
| Covered procedures | Set by a national committee, currently including spinal surgery, hip and knee replacement, tonsil surgery, hysterectomy, cholecystectomy, shoulder arthroscopy and cardiac catheter procedures[2] |
| Statutory entitlement, Israel | A right to obtain a second opinion at the patient’s own initiative, with a duty on the clinician and institution to assist[3] |
| Independently reported | |
| United Kingdom | No legal right to a second opinion, though a clinician will rarely refuse to refer for one[4] |
| Bands apply only to the rows beneath them. The German statutory text was read in a private reproduction because the official site could not be retrieved; the procedure list and patient-facing rules come from the committee’s own published material. | |
Second medical opinions are independent assessments of a diagnosis or a proposed treatment by a clinician other than the one who made it. A right to one exists in some systems and not others, is funded in fewer still, and no system was found that funds a second opinion obtained in another country.
The German scheme, in detail
Germany operates the most developed statutory scheme located. Insured persons are entitled to an independent second opinion before certain planned procedures, targeted at operations where the frequency of performance creates a risk of indication creep; the second opinion may not come from the doctor or facility that would carry out the procedure; and the national committee that designates which procedures carry the entitlement must add at least two further procedures each year. The treating doctor must tell the patient of the right orally, point to information on qualified providers, hand over written information on the procedure and its alternatives, and do so at least ten working days before the planned procedure, or at least fifteen working days for procedures specially designated.[1]
The current list of covered procedures includes amputation for diabetic foot syndrome, aortic aneurysm procedures, carotid artery procedures, spinal surgery, tonsillectomy and tonsillotomy, locally confined non-metastatic prostate carcinoma, hip replacement, knee endoprosthesis, pacemaker or defibrillator implantation, cholecystectomy, hysterectomy, shoulder arthroscopy, and cardiac catheter examinations and ablations. Providers of second opinions must hold a procedure-specific qualification, must be free of conflicts of interest that would compromise independence, and must be approved to bill by their regional association of statutory health insurance physicians.[2] The patient-facing rules are that the second opinion is voluntary, the patient may choose any qualified doctor, records are supplied free of charge, a written summary is available on request, and the decision whether to proceed remains the patient’s.[5]
Several of the listed procedures, notably hip and knee replacement and spinal surgery, are among the operations most commonly sought abroad. A German patient contemplating travel for one of them therefore has a funded domestic route to a second view, which is a materially different starting position from a patient in a system without one.
A right to obtain is not a right to funding
Israel’s Patient’s Rights Act gives a patient an entitlement to obtain, at their own initiative, a second opinion as to their medical care, and places a duty on the clinician and the medical institution to give the assistance required to exercise it.[3] That is a right to obtain rather than a right to have one funded. Research on the Israeli system reports that second opinions are among the largest expenditure items of the health funds’ supplementary insurance programmes, and that physicians identify a gap between the patient’s right and its coverage under national health insurance, along with disparities between the centre and the periphery and between public and private provision.[6]
The United Kingdom has no legal right at all. NHS patient information states this plainly while noting that a clinician will rarely refuse to refer for a second opinion.[4]
What second opinions change
The only systematic review located reports that second opinions most often agree with the original assessment, that between 10 and 62 per cent produce a major change in diagnosis, treatment or prognosis, that changes to treatment advice are more common than changes to diagnosis, and that the accuracy of second opinions over follow-up is generally unknown; the authors describe the literature as limited and call for standardised methods and outcome measures.[7] A range from 10 to 62 per cent is not a usable estimate, and any single circulating figure for how often second opinions overturn a diagnosis should be treated as unsupported until its own primary source is produced.
Survey work gives a picture of who seeks them and why rather than of their accuracy. A national telephone survey in Israel found that of 848 respondents, 344 had sought a second opinion; the main reasons were doubts about the diagnosis or treatment, seeking a sub-specialist, and dissatisfaction with communication; a third chose the second doctor on a friend’s or relative’s recommendation and about half searched the internet; and orthopaedic surgeons were consulted most often.[8]
Second opinions and treatment abroad
No provision was found in European cross-border healthcare law, in the European Commission’s cross-border material, or in the German scheme establishing a funded second opinion obtained in another country. The German scheme’s own provider requirements, a procedure-specific qualification plus billing approval from a regional association, confine it domestically in practice. This absence is reported as a negative finding.
The direction that does occur is the reverse: a patient who has been offered an operation at home seeks a view from a provider abroad, or a patient who has been offered an operation abroad seeks a view at home. Neither is a second opinion in the statutory sense, and in the first case the second opinion is being given by a party that stands to be paid if it recommends treatment, which is precisely the independence condition the German scheme is built to secure.
See also
- Clinical Referral, the route by which a second opinion is usually arranged
- Shared Decision-Making, the process a second opinion is meant to inform
- Diagnostic Tourism, travel undertaken for assessment rather than treatment
- Conflicts of Interest in Medical Tourism Research, on independence where the adviser is also the provider
References
- Sozialgesetzbuch, Fuenftes Buch, section 27b (Zweitmeinung). Read at lxgesetze.de, a private reproduction; last amendment shown 24 July 2026. Verified against primary record only to the extent that this reproduction was opened and read; the official text at gesetze-im-internet.de could not be retrieved and the provision should be confirmed there before being relied on.
- Gemeinsamer Bundesausschuss. Zweitmeinung bei planbaren Eingriffen. Most recent dated item a committee decision of 7 October 2026. Verified against primary record: the topic page was opened and the current procedure list and the provider requirements read. Retrieved 10 October 2026.
- State of Israel. Patient’s Rights Act, 1996, clause 7, English text. Verified against primary record: the English text was opened and clause 7 read. This is an unofficial translation hosted by a non-governmental organisation and contains visible typographical errors; the Knesset or Ministry of Justice version should be consulted before quoting. Retrieved 10 October 2026.
- NHS 111 Wales, Welsh Ambulance Services NHS Trust. Second opinion. Last updated 21 June 2022. Verified against primary record: the page was opened and its statement that there is no legal right to a second opinion read. Retrieved 10 October 2026.
- Gemeinsamer Bundesausschuss. Patientenmerkblatt Zweitmeinungsverfahren. January 2026. Verified against primary record: the patient leaflet was opened and the voluntariness, provider choice, free records and written-summary provisions read. Retrieved 10 October 2026.
- Israel Journal of Health Policy Research. Qualitative study of orthopaedic surgeons’ and neurologists’ attitudes to second opinions. Volume 1, issue 1, July 2012. Independently reported: the indexing record and abstract were opened; the full text was not read. Retrieved 10 October 2026.
- Payne VL, Singh H, Meyer AN, Levy L, Harrison D, Graber M. Patient-Initiated Second Opinions: Systematic Review of Characteristics and Impact on Diagnosis, Treatment, and Satisfaction. Mayo Clinic Proceedings 2014;89(5):687-696. Independently reported: the publisher record and abstract were opened; the journal full text was not read. Retrieved 10 October 2026.
- Shmueli L, Davidovitch N, Pliskin JS, Balicer RD, Hekselman I, Greenfield G. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Israel Journal of Health Policy Research 2017;6(1). Independently reported: the indexing record and abstract were opened and the survey figures read; the full text was not read. Retrieved 10 October 2026.
Sourcing note: the German procedure list is taken from the committee that sets it rather than from the federal health ministry’s English-language page, whose list is dated 2023 and is shorter than the current one. The German statutory text and the Israeli Act were both read in unofficial reproductions, which is recorded in their references. A 2026 amendment creating procedures for which proof of a second opinion becomes a condition of payment was noted in the reproduction consulted and is not reported here, because it could not be confirmed against the official text.