Some of the nation's largest employers have for years formed captive insurance companies to reduce the risk and cost of employee health benefits. Now that strategy is becoming more popular among smaller and medium-size.

"People don't realize just how big this business is," said George O'Donnell, technical director of the health and employee benefits risk management unit at Aon Risk Solutions in New York.

It's big enough that there are more than 6,000 captives worldwide, up from 1,000 in 1981. The Self Insurance Institute of America held a panel discussion on the topic at its recent national conference in Chicago.

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