Competition between hospitals makes you 0.1% happier?

Stop press! After poking the BMC offices, my comments went live today; you can read them here.

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A couple of months ago I sent some comments into BMC Health Services Research in response to this paper. The authors claim that hospital competition in the Netherlands CAUSED increases in patient satisfaction. There are 4 major flaws in this paper, causing misleading conclusions to be drawn in an area of intense political activity. Most notably, the causal increase is one-thousandth of the satisfaction scale. Wow! If I was one-thousandth of the way closer to total satisfaction, I’m not sure I’d notice. I’ve never seen a paper make a fuss about a regression coefficient so small that it had to be written in scientific notation! It is statistically significant because there are more than 20,000 patients in the dataset… so what?

I note that one of the authors works for a well-known consulting firm working in re-organisation of secondary care in the Netherlands, but of course I am entirely reassured by the statement that the authors have no competing interests.

NB these represent my professional opinion and are not (necessarily) the view of the University of London or Kingston University.

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