If 1994's $61.3 billion in health care mergers seemed to put the health care industry on the road to a world of acquisition-hungry mega-merged drug, device and service companies, 1995, with its $63.7 billion in acquisition activity, has been the year of the unexpected: both in terms of what happened and what didn't.

This articles reviews 1994's intense merger activity. The big hospital and home infusion mergers have created enormous national organizations, but the rise of locally powerful integrated systems undercuts their clout. Consolidation in the device industry reflects the devaluation of incremental technological improvements and providers' needs to cut their list of separate suppliers. Diagnostics gained new players as biotechs, which believe they can successfully mix diagnostic and therapeutic product marketing efforts, bought into the business. Drug firms were energetic acquirors, but few of their deals were copycat transactions. Most were driven by very different motivations, including the idea of acquiring the capability to cover an entire episode of care, not merely the drug used.