Ten percent of all Medicare beneficiaries account for 59%
of all program expenditures. Although studies have shown
that high per-capita spending does not directly correlate
with high-quality care, little attention has been paid to
where the high-cost areas are in rural communities and
what strategies can be used to effectively manage their
The purposes of this study were to: 1) assess the
relationship between service utilization patterns and
costs for rural Medicare beneficiaries across the rural
continuum (i.e., in places where Medicare spending is
highest, what services are most likely to be used?); 2)
examine the relationships between rural beneficiaries'
service utilization and healthcare delivery market
structure; and 3) evaluate strategies and policies to
address high costs in specific rural contexts.