title: Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US.
abstract: BACKGROUND
  Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States.
  
  
  METHODS
  We examined a nationally representative sample of 13,980 adults (age >or= 18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data.
  
  
  RESULTS
  Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically significant relationship between patient satisfaction and total healthcare expenditure (p = 0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures.
  
  
  CONCLUSIONS
  Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost-satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure.
  
  
  CONCLUSIONS
  Our study adds to the literature on health care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health care spending.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA. fuz@ccf.org
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.forename: Nan
authors.initials: N
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011336:Probability; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D012737:Sex Factors; D017749:Total Quality Management; D014481:United States