The increasing trend of HCE calls for a deeper evaluation of geographical variations of elderly expenditures for health services compared with their health care burden. Using 2019 data at the municipality level on the elderly population (65+) in Friuli-Venezia Giulia, we estimate Spatial Error Models for the total per-capita health expenditures and the percentage of individuals with high health care burden (classified into Resource Utilization Bands). The determinants of HCE and health care burden are investigated and the models’ residuals are examined to derive health-economic scenarios of great relevance for policy-makers.