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The 1974 Hawaii Prepaid Health Care Act has long defined Hawaii’s healthcare market. The mandate has resulted in Hawaii experiencing a particularly high enrollment in commercial and government-sponsored plans. This high enrollment combined with the dominance of Hawaii Medical Service Association means that the health plan sector tends to see little change. However, the health systems in the area have been seeing greater activity with the announcement of several construction projects. In addition, there continues to be a physician shortage in the market which will need to be addressed either by legislation or efforts from the market’s physician groups.