The authors thank Dr. Stephen S. Mick and Dr. Yasar A. Ozcan in the Department of Health Administration at Virginia Commonwealth University for their comments and thoughtful inputs on a very early draft. In addition, the authors thank Mr. Richard Walker from the VHI organization for his help. The authors thank Dr. Leslie S. Stratton in the Department of Economics at Virginia Commonwealth University for her help with the development of the econometric models and the statistical tests. The authors also thank two anonymous reviewers’ valuable comments for the manuscripts.