The top hospital had worse outcomes. Is it worse?

Question

A report shows that a renowned specialist hospital has a higher death rate for a certain surgery than a small community clinic nearby. A journalist concludes the famous hospital is actually the more dangerous place to have the operation.

Explain how self-selection could produce this result even if the specialist hospital is genuinely better.

Accepted Answer

The sickest patients flow to the specialists. Difficult, high-risk, and complicated cases get referred to, or seek out, the renowned center precisely because it handles what others cannot. The community clinic tends to keep the straightforward, lower-risk cases and send the hard ones onward. So the two hospitals are not treating comparable patients: the specialist center starts with sicker people who are more likely to die no matter how good the care. This sorting of patients by severity into hospitals is a form of self-selection, sometimes called referral bias. Why the bias runs against the …

The top hospital had worse outcomes. Is it worse?

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