• Jordan A Gliedt, Rebekah J Walker, Kaiwei Lu, Aprill Z Dawson, and Leonard E Egede.
• Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI.
• Spine. 2021 Oct 15; 46 (20): 140914171409-1417.

Study DesignCross-sectional study.ObjectiveThe aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs).Summary Of Background DataSRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population.MethodsFifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008-2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE.ResultsMean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile.ConclusionExpenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence: 2.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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