This chapter investigates whether signing more hospital contracts with Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), hospital affiliation in a system, having more system hospital members located in the same area, and increased competition from area hospitals, contributes to improvements in the cost efficiency of U.S. Midwestern hospitals. Hospitals may offer HMOs and PPOs discounts on contracts to provide health care services to firm employees enrolled in HMOs and PPOs (discounts would lead to smaller price mark-ups over costs for hospital services). Enacting policies to enhance cost efficiency may help hospitals maintain a specified level of profits.

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