1.  American Health, part of a larger purchasing group, entered an agreement with another supplier, Hafslund said.

2.  Another index by the purchasing group indicated that weakness was spreading to nonmanufacturing industries.

3.  Enthoven developed a plan to establish a competitive health care system that would pool employers and their employees, self-employed people and the uninsured in large purchasing groups.

4.  For a while, the purchasing groups were winning this battle by using their muscle to demand lower premiums.

5.  In Racine, Wis., three large self-insured employers joined three public agencies, the city and county governments and the school system, to create a purchasing group.

6.  In the world of medical supplies, the purchasing groups are financed not by the hospitals but by the medical supply companies themselves.

7.  Mark W. Isakowitz, a lobbyist at the National Federation of Independent Business, said the new purchasing groups were his top priority in the insurance legislation.

8.  New purchasing groups of both large and small employers are being organized in Salt Lake City, Houston, Atlanta and other cities.

9.  Purchasing groups, in a variety of forms, have been used with varying success around the country.

10.  Small employers are scrambling to join health care purchasing groups that would give them more bargaining power, but such groups are scarce in many parts of the country.