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20 HMOs ambulatory encounters ambulatory health center California casemix Community Health Plan constant returns cost function cost of providing covariance matrix data reporting requirements economic economies of scale efficiency elasticities of substitution estimated evaluation expenditures federally qualified HMOs full-time equivalent Group Health Association Group Health Cooperative group practice health care costs health center services Health Maintenance Organization Health Services HMO Act HMO and non-HMO HMO costs HMO development HMO enrollees HMO national data HMO performance hospital services incentive increasing returns inpatient services input prices IPAs learning-by-doing marginal costs Medicaid medical staff services membership national data reporting number of ambulatory operational HMOs PGPs practice and staff prepaid Program quarterly restrictions returns to scale sample Seemingly Unrelated Regressions share equations Shephard's Lemma staff model HMOs statistical cost analysis Table third party payments total HMO enrollment traditional system translog translog cost function types of HMOs