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 ≥ 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.

Limitations: 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 health­care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health­care spending.

Key words: :

• Cost analysis
• Extended estimating equation (EEE)
• Healthcare expenditure
• Healthcare quality
• Patient satisfaction