State-operated PCFs represent one of several public policy options for addressing the dual problems of lack of available coverage and affordable coverage. Although they have existed for nearly three decades, relatively little is known about their performance. This study addresses two related issues. The first is essentially descriptive: How do these PCFs operate and what have been their successes and failures? The second is prescriptive: What role should these organizations play as states look to solutions to their medical malpractice crises?