Large regional differences have long been noted in hospital admission rates, in average length of stay, and in the days of care rate for Medicare beneficiaries. This paper provides an overview of national trends in the use of inpatient hospital services by Medicare beneficiaries and reviews past work on geographic differences in hospital use. It reassesses Medicare program experience and provides some new views on the subject. Perhaps the most surprising finding from this re-examination of regional differences in hospital use is that the number of days of care per capita in one area can differ substantially from that of another area while the per capita costs of care can be nearly equal. The major conclusion from this study is that no one utilization statistic is adequate for supplying information for the many current policy issues. Rather, there is a continuing need to understand national trends and regional differences in hospital utilization and to study the disparities by area in Medicare per capita spending for program benefits.