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1. King County Medical Blue Shield was renamed Regence Washington Health in April 1997, after merging with Pierce County Medical Blue Shield.

2. Area Resource File as of February 1996, Office of Research and Planning, Bureau of Health Professions, U.S. Department of Health and Human Services.

3. Ibid.

4. American Hospital Association, database of the 1995 Annual Survey of Hospitals. Figures do not include long-term care units in hospitals.

5. Estimates are based on the 1996 American Medical Association Master File and 1996 American Osteopathic Association Master File. Includes physicians in direct patient care, excluding some specialties (radiology, anesthesiology, pathology), residents and fellows.

6. State Legislative Health Care and Insurance Issues: 1995 Survey of Plans, Blue Cross and Blue Shield Association, 1996.

7. Health Care Financing Administration, 1997. Medicare HMO enrollment by county.

8. Regence Washington Health (formerly King County Medical Blue Shield) enrollment as of August 1996.

9. Rubin, R., and Beddingfield, K. Rating the HMOs. U.S. News and World Report, September 2, 1996, p. 121.

10. Washington State Office of the Insurance Commissioner, 1994.

11. InterStudy Competitive Edge Regional Market Analysis 6.2, February 1997.

12. Department of Social and Health Services, Medical Assistance Administration. Healthy Options Enrollees, June 1997.

13. Enbysk, M. Medalia’s Primary Mission: Name Brand Quality Health Care. The Washington CEO, April 1996.

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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.