1. National news reports indicate that CIGNA, the national insurance company, intends to acquire Healthsource. The impact of this sale on Healthsource’s Little Rock subsidiary is not yet clear.

2. Per capita income in Little Rock is about 8 percent lower than the U.S. average, while median household income in Little Rock is a full 29 percent lower than the U.S. average. Sources: Area Resource File as of February 1996 Office of Research and Planning, Bureau of Health Professions, U.S. Department of Health and Human Services. Population data are 1995. Income data are 1993; Bureau of the Census, 1990 projected to 1995 by CACI, Inc.

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

4. U.S. Health Care Financing Administration, MedPar Data, 1991.

5. Area Resource File as of February 1996, Office of Research and Planning, Bureau of Health Professions, U.S. Department of Health and Human Services. Data reflect a five-year rolling average from 1988 to 1992.

6. National Center for Health Statistics, Centers for Disease Control and Prevention, March 1997.

7. American Hospital Association, database of the 1995 Annual Survey of Hospitals. Figures do not include long-term units in hospitals. Occupancy rates range from 37 to 75 percent of staffed beds for general acute care hospitals in the Little Rock/North Little Rock metropolitan area (excluding federal facilities). All estimates are unadjusted and therefore do not reflect differences in case mix of age/sex differences between Little Rock and the U.S. populations, or the impact of migration.

8. The Little Rock/North Little Rock MSA has 11 percent more primary care doctors per 1,000 residents and 47 percent more specialists than the U.S. average. Estimates are based on the 1996 American Medical Association Master File and the 1996 American Osteopathic Association Master File. Includes physicians in direct patient care, excluding some specialties (radiology, anesthesiology, pathology), residents and fellows.

9. Organization of the Health Care System for more details about the entry of these companies into the Little Rock market.

10. U.S. Bureau of the Census, Health Insurance Coverage: 1993, Statistical Briefing 5B94-28; Oct. 1994.

11. Arkansas Employment Security Department, 1990-1996; Employee Benefits Research Institute, "Sources of Health Insurance and Characteristics of the Uninsured," February 1996.

12. Greater Little Rock Chamber of Commerce, "Taking Care of Business," 1996.

13. The state maintains authority over benefits provided by local districts because those benefits are financed in large part through state contributions.

14. American Hospital Association, database of the Annual Survey of Hospitals. Figures do not include long-term care units in hospitals, beds at Little Rock’s Department of Veterans Administration facility and two smaller federal facilities located on area military bases.

15. Officials of St. Vincent’s Infirmary declined to be interviewed for this site visit, so impressions and observations about the institution are based on reports from other respondents.

16. Subsequent press reports announced Columbia/HCA’s intention to build a new facility.

17. Plunket, Chuck. "Columbia/HCA Seeks to Expand its Presence in State," Arkansas Democrat Gazette; February 2, 1996, p. G- 1.

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

19. Some respondents claimed that less than 5 percent of all physicians in the area work in hospital-owned practices, with Baptist Health System owning the largest share. Baptist reports purchasing practices containing 80 physicians with plans to increase this number to 120 over the next several years. According to respondents, the pace of these acquisitions has slowed down significantly over the last few years.

20. InterStudy Competitive Edge Regional Market Analysis 7.1, June 1997.

21. Strategic Consulting Services, "Focus: Little Rock," Executive Bulletin, Spring, 1995, p. 5.

22. Plunket, Chuck. "Healthsource mailing fosters hospital talks," Arkansas Democrat Gazette, December 17, 1996, p. D-1; According to the terms of the Healthsource/St. Vincent’s joint venture, Southwest Hospital is the only other general hospital provider in Little Rock that Healthsource patients are allowed to see without an additional payment for going out-of-network.

23. Greater Little Rock Chamber of Commerce, Taking Care of Business, 1996, p. 45.

24. Statement of John Shelnutt, Arkansas Institute for Economic Advancement, before the University of Arkansas at Little Rock Economic Outlook Conference, May 24, 1996.