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 spending patterns.

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.