It also has reduced operating and maintenance expenses, which will help minimize the profit margin squeeze in the wholesale business.

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It was driven largely by leverage on higher revenues, lower repair and maintenance expense, reduced credit card fees and utility costs.

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Analysts predict that today's 1, 000 or so health-maintenance organisations will be reduced to 50 within a few years.

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The report said this reflects higher prices for labor, electricity and maintenance, as well as reduced by-product credits resulting from lower base-metals prices.

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Rogers, is that for every dollar in operating and maintenance expense that can be reduced in a merger, up to five dollars can be invested in infrastructure upgrades.

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