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 & Medicaid Services claims data. Main Outcome Measures The survey included 3 questions about perceived un-met need for care, 4 questions about the perceived quality of ambulatory care, and 3 questions rating the perceived quality of overall care. Results Of 4000 Medicare beneficiaries sampled, 160 ( 4%) were ascertained to have died or to be living in a long- term care facility. Of the remaining 3840 potentially eligible beneficiaries, 2515 ( 65%) responded. Per capita expenditures were highly related to receiving more medical care, such as mean number of ambulatory visits to physicians in the past year ( range from lowest to highest expenditure quintile, 3.4- 3.9; 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.
