OBJECTIVES: Both cost and quality are major concerns in the U.S. healthcare system. The objective of this study is to identify the relationship between cost and quality from the healthcare consumers' perspective. METHODS: Using the 2003 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of 13,980 adults (age = 18) with their overall self-rating of healthcare quality (from 0 (worst healthcare possible) to 10 (best healthcare possible)) were included in the study. Given the heavily right-skewed distribution of the cost data, a generalized linear model with log-link function was employed to identify the relationship between healthcare quality rating and total healthcare expenditure, after controlling for individual demographic covariates, comorbidity profile (AHRQ comorbidity software), and functional and activity limitations. All statistics were adjusted using the proper sampling weight from the MEPS. RESULTS: The average annual healthcare expenditures ranged between $4000 and $6000 with the mean value $4779 for all individuals rating their received healthcare quality from 0 to 10. Individuals with higher ratings for their healthcare quality did not spend more compared to individuals with lower ratings (p = 0.72). No non-monotonic relationship was identified either. As one expected, comorbidities and functional and activity limitations were significant predictors of the annual healthcare expenditure. An individual-level fixed-effect model using the 2003-2004 panel of the MEPS revealed the same relationship between healthcare quality rating and total healthcare expenditure. CONCLUSION: This study adds to the literature of healthcare quality by providing additional empirical evidence from the healthcare consumers' perspective at the U.S. national level. Healthcare quality improvement, in regards to patient satisfaction, may not require additional healthcare spending.