The result is not consistent with earlier research (Rosko, 2004a). We found a positive estimated coefficient for the relationship between hospital efficiency and having a major safety net hospital within a region. This finding may result because major safety net hospitals treat the most costly and complicated patients, leaving other hospitals in the region with less costly or complex patients to treat. In turn, this may make these providers appear efficient. Contrary to expectations, the negative estimated coefficient for Medicaid share ( p < .01) indicates that hospitals with high Medicaid loads are less efficient. We found a positive estimated coefficient ( p < .05) for systemaffiliated hospitals, indicating that system hospitals tend to be more efficient than non system hospitals. This is similar to the results of Rosko et al. (2007). The results also indicated that teaching hospitals are more efficient than non teaching hospitals ( p < .01).