Large-scale enterprises tend to operate more comfortably in stable and secure circumstances, and their managerial bureaucracies tend to promote the status quo and resist the threat implicit in change.

Even Bank of America, which comes closest to having a national network, has branches in only 29 of the 50 states.

In the operational management process of commercial health insurance business, there is a need to balance interests of insurance companies, medical service providers and the insured.