Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care

CONTEXT: Wide variations in Medicare expenditures exist across regions, but little is known about whether beneficiaries residing in low-expenditure regions perceive receiving lower-quality care than those in high-expenditure regions. OBJECTIVE: To evaluate how Medicare beneficiaries' perceptions of their health care are related to per capita expenditure in the areas where they live. DESIGN, SETTING, AND RESPONDENTS: A probability sample of Medicare beneficiaries living in households in the United States was surveyed by a combination of mail and telephone in 2005. Each respondent was allocated to 1 of 5 quintiles, depending on mean age-, sex-, and race-adjusted per capita Medicare expenditures based on Centers for Medicare P < .001 for linear trend) and more cardiac tests (respondents reporting receiving tests in past year, 158/387 40.1% to 468/739 63.5%; P < .001 for linear trend). However, 7 of the 10 measures of perceived quality, including perceived unmet needs for tests and treatment (respondents reporting unmet needs, 15/387 3.9% to 37/739 5.0%; P = .25 for linear trend) and spending enough time with physicians (respondents reporting adequate time, 311/387 88.7% to 603/739 87.0%; P = .94 for linear trend), were unrelated to expenditures, while the overall rating of perceived quality of care was higher in the lower-expenditure areas (respondents reporting overall care rating of 9 or 10, 242/387 63.3% to 404/739 55.4%; P = .008 for linear trend). CONCLUSION: In this representative sample of Medicare beneficiaries, no consistent association was observed between the mean per capita expenditure in a geographic area and the perceptions of the quality of medical care of the people who live in those areas.