• Alex Z Fu and Nan Wang.
• Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA. fuz@ccf.org
• Curr Med Res Opin. 2008 May 1; 24 (5): 1385-94.

BackgroundBoth 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.MethodsWe 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.ResultsAverage 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.LimitationsPatient 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.ConclusionsOur 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.

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