"The difference between employers' cost projections before and after making changes to their benefit programs suggests we're going to see some considerable cost-shifting to employees next year, especially among smaller employers," Bos said.
The Kaiser study found that overall this year, the average cost of health care coverage for a family is $9,950 ($3,695 for a single worker) this year. Health maintenance organizations (HMOs) are the least expensive type of plan at $9,504 a year for a family and $3,458 for a single worker, while preferred provider organizations (PPOs), which are the most common type of plan and cover 55 percent of workers who have health care, are the most expensive. PPO family premiums average $10,217, while single coverage is $3,808.
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What We Pay Average annual health care premiums for covered U.S. workers, 2004.
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Among all plans, workers on average pay $2,661 of the $9,950 annual cost for family coverage and $558 of the $3,695 for single coverage. In HMOs, workers pay $2,674 for family coverage and $552 for single, on average. In PPOs, the figures are $2,691 and $573.
The percentage of premiums borne by workers has remained more or less constant since 1988, at just under 30 percent, the survey found, though Altman said this is a constant share of a steadily rising dollar amount.
The survey found employers only mildly optimistic about new steps to control costs. About 15 percent said they think disease management -- the treating of long-term illnesses on an integrated, coordinated basis, rather than dealing with each problem as it arises -- would be "very effective" in cutting costs. Larger employers with the resources to carry out disease management were the most optimistic about it.
Some experts think consumer-driven health plans -- particularly health savings accounts, which combine a high deductible policy with a tax-free investment account -- hold much promise. Insurers such as Aetna have added such plans to their offerings and think they are promising.
Rowe said neither employers nor providers, such as doctors and hospitals, have come up with effective ways to control costs, and neither had insurers since the "backlash against restrictions [imposed by] managed care."
He said a key finding in recent years has been that people "want to control health care cost increases without restricting choice," and that is where the consumer-driven plans come in.
He said that these plans may not work for all consumers but that he expects them to evolve in ways that will improve their appeal. Current consumer-driven plans "are Release 1.0, if you will," he said.
Advocates of consumer-driven plans argue that they use market forces to hold down health care spending because the consumers get a tax break for saving and then can keep money they don't spend on health care. This gives them an incentive to avoid unnecessary treatment and to shop for the lowest-cost providers.
Aetna said employer interest is rising rapidly, noting that a survey of its employer-customers found that medical costs for those with consumer-driven plans rose only 3.7 percent last year, compared with an 11 percent rise for employers using more conventional plans.
And a recent survey by Deloitte Consulting found that three-quarters of employers that have had a consumer-driven plan for two years say the plans change employees' health care purchasing behavior.
Kaiser found, though, that employers are less optimistic about their potential. Only 11 percent said they expect these plans to be very effective as a cost-containment strategy, though 42 percent said they would be somewhat effective.
