Getting more for their dollar: a comparison of the NHS with California's Kaiser PermanenteCommentary: Funding is not the only factorCommentary: Same price, better careCommentary: Competition made them do it

This article contains so many flaws, it is surprising that the BMJ
first allowed it to be published and then gave its findings so much
prominence. Several respondents have already pointed out the perverseness
of the adjustment for ‘purchasing power parity’ in the article. Another
major flaw is the lack of information on the health status of the
populations covered by Kaiser Permanente and the NHS. As health status
will be the major predictor of use of health services, this information
should have been included in the article – otherwise its conclusions are
meaningless. The authors of the article claim the two populations have
similar health status but all the references about the health status of
Kaiser Permanente population are to ‘unpublished data’. As a minimum, we
need to know the age-sex specific death rates for the two populations.

Ideally, we also need to know about other factors, such as smoking status
and the prevalence of obesity, that can have a major impact on health, as
well as chronic disease prevalence rates in the two populations. The
authors need to post this information on the BMJ website urgently, before
the credibility of their article is damaged still further.