How has TennCare affected both the quality of care received by Tennessee residents, and the structure of the health care delivery system in Tennessee? Researchers at Duke University evaluated three aspects of TennCare: 1) how the delivery of care has changed in terms of efficiency, quality, and cross-subsidies imposed on the non-TennCare population; 2) the antitrust provisions of Blue Cross's requirement that participating providers under its state employee contract also participate in TennCare (the "cram-down" provision); and 3) the institutional, administrative and legal issues raised by TennCare. Secondary data from Tennessee and four contiguous states was analyzed using pre-/post-comparisons as well as cross-sectional analyses. In addition to secondary data bases such as the AHA's Annual Survey of Hospitals, Medicare Provider of Service Files, and Tennessee Joint Annual Reports, primary data was collected from patient interviews, hospital charts, and physician interviews. The objectives of the study were to investigate whether savings have been realized, and if so whether they have resulted from lower quality or diminished access to care. In addition, the researchers examined whether Blue Cross "cram down" has pro- or anti-competitive consequences.