atients in areas where more money is spent on medical care do not appear to fare better or to be more satisfied, according to two studies released yesterday in The Annals of Internal Medicine.

Surveys of Medicare spending have long shown wide differences among regions of the country in the amounts spent on health care, with little evidence to suggest that higher levels result in better outcomes.

In the new studies, researchers from the Veterans Affairs Outcomes Group and Dartmouth Medical School first looked at how much was spent on care in the last six months of patients' lives to create a map of spending levels across the country.

They then looked at the records of nearly a million Medicare patients who suffered hip fractures, colon cancer or heart attacks from 1993 to 1995 to see how the patients fared.

The researchers found no significant differences in death rates or patients' levels of functioning. Patients reported different levels of satisfaction on their surveys, but those discrepancies cut across spending lines with no clear pattern, the study said.

The researchers said the differences in spending were unlikely to be explained by the seriousness of their illnesses; patients seemed to be roughly as sick everywhere. In a second article, the researchers analyzed the extra spending and found that it went primarily toward more frequent hospitalizations, diagnostic tests and referrals to specialists.

If spending across the country could be held to the levels used in the least expensive area, the overall Medicare cost would be cut by 30 percent, they estimated.