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Big, better, best?

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<abstract>Even as some insurers gain national size through mergers and acquisitions, competition is still a local battle. The number of health maintenance organizations in the country dropped 30% from 1999 to 2003, falling from 643 to 454, according to Interstudy Publications, whihc tracks the entities holding HMO licenses in their state of primary operation. Tables: The 11 largest insurance company managed care deals since 1997; largest public managed care companies by revenue 2002-2003</abstract>
<note type="statement of responsibility">by Meg Green</note>
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<text>March  2004 ; p. 78-83</text>
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