Congressional interest in second surgical opinion programs (SSOPs) as one method to reduce the cost of health care dates from the mid-1970s. The Omnibus Budget Reconciliation Act (P.L. 99-509) of 1986 mandated a report by the Secretary of Health and Human Services to Congress on utilization review in Medicaid agencies. The report was to assess SSOPs and inpatient hospital preadmission review programs, including whether such programs impede access to care. This Note, a critical review of the literature on SSOPs, was developed as background information for the Secretary's report. It considers (1) whether SSOPs are effective mechanisms for reducing health care costs and (2) how SSOPs affect outcomes of patient care. The authors also discuss how the literature addresses a number of concerns on access and quality that are included in Section 9432 of P.L. 99-509.