Is it that the bigger the city the better the hospital?

I would say it is often the case that the best hospitals are in large cities and near major universities. Best meaning up to date on the latest research, and most likely to attract some of the best doctors and surgeons. However, it is not always the case. Sometimes, new procedures are being done in smaller cities. You can’t assume, you have to research who is the leader in whatever problem you have.

The best hospital in my area is in a one stop light small town. It’s also affiliated with Columbia University. Size doesn’t always matter. Wait, that doesn’t sound right.

Generally speaking yes, especially when it comes to less common conditions.

Funding and professional standards seem to matter for patient outcomes at hospitals.

The best hospitals seem to be related to the non-profit HMOs, the VA, universities, or specialty practice all of which would demand measurable medical excellence.

On the other end of the spectrum are hospitals that have been privatized, considered a cash-cow by a corporation and everything possible will be done to get the billable procedure done at the lowest cost possible.

Big Cities for the good ones? Usually… but be advised that libertarians (Kochs) are messing with the hospitals in NYC, They make humongous donations with strings attached (like seats on the board) and proceed to put pressure toward union-busting and ‘re-organizing’ to get rid of people who might be found to ‘not fit’ anymore if they have a humanitarian streak in them.