The marketing campaigns by the industry giants have put heretofore comfortable smaller providers into full defense mode as the two sides fight for customers who are getting more say in where they go for health services. While Columbia/HCA, Nashville, Tenn., has apparently won the advertising battle by blitzing the media recently with its $40 million ad campaign, smaller hospitals are hoping to win the war with aggressive marketing tactics. One of the generals fighting on the side of the smaller hospitals is Lee Snedaker, whose Snedaker Communications Group in Salt Lake City, Utah, creates "syndicated" advertising campaigns for local providers. But his support of smaller providers has not gone without a hitch.

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