The Dartmouth Atlas Frequently Asked Questions section asks: “How do you ensure some patients were not more severely ill than others?” Here’s the Dartmouth answer: “The study only focused on patients who died so we could be sure that patients were similarly ill across hospitals. By definition, the prognosis of all the patients in the cohort was identical – all were dead after the interval of observation. Therefore, variations cannot be explained by differences in the severity of individuals’ illnesses.”
So, let’s see. A hospital where a senior gets minimal care after an acute MI and dies in 36 hours is efficient, but a hospital where his identical twin got a full range of care and survived, only to die of a second MI on the golf course six months later is inefficient. OK, I get it. Similarly dead. Even similarly ill, at the start. But where would you go for care? And who would ever judge “efficiency” this way?