International ratings agency Standard & Poor's (S&P) has revised its 2002 outlook on the health insurance/managed care industry, to negative from stable, due to mounting negative pressures.

S&P insurance ratings group director Shellie Stoddard said: "Rising medical costs, the current weak economy, and a growing sense of consumerism in health benefit choices are mounting the pressures on the health insurance industry.

"This stress will be felt most acutely by companies with weaker balance sheets, lacklustre earnings, and smaller overall scales of membership and market concentration."

Stoddard said in the coming year, smaller, geographically concentrated plans would be affected far more than the larger, diverse companies.