In a big year for deal-making, the health care industry is a standout.

Large drugmakers are buying and selling businesses to control costs and deploy surplus cash. A rising stock market, tax strategies and low interest rates also are fueling the mergers and acquisitions.

It's all combining to make 2014 the most active year for health care deals in at least two decades.

The industry has announced about $438 billion worth of mergers and acquisitions worldwide so far, about 14 percent of the $3.2 trillion total for all industries, according to data provider Dealogic.

Overall, the business of mergers and acquisitions M&A is on track for its best year since 2007, the year before the financial crisis intensified.

Health care has been a sleepy niche of M&A until recently, but the giant has been awakened, says Ken Menges, a senior partner handling M&A at law firm Akin Gump in New York.

To a large extent, says Ashtyn Evans, pharmaceutical and biotech analyst with investment firm Edward Jones in St. Louis, the deals are being driven by cost pressure on the entire health care system as insurers and government health plans increasingly hold down or even reduce reimbursements to drug, device and service providers.

Companies also want to expand market share and boost their portfolios in hot areas such as drugs for cancer and hepatitis C, she says.

Drugmaker Merck & Co., for example, agreed in June to pay nearly $4 billion for Idenix Pharmaceuticals Inc. to combine that company's hepatitis C medicines with its own.

Taxes are another reason behind the rush to the negotiating table.

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Health care's big deal