Altman and others who have watched cost-containment efforts over the years have seen such ideas as managed care burst onto the scene and appear to bring costs to heel. But each time, the new strategy has lost effectiveness, and costs resumed their seemingly inexorable climb.
The current "next big thing" is what has been dubbed "consumer-driven" health care, which combines high-deductible insurance with a fund that the individual can use to cover routine costs. In these arrangements, consumers are allowed to accumulate unspent money in the fund, giving them, theorists argue, an incentive to shop and eliminate unnecessary spending.
The Kaiser survey found much interest in these types of arrangements but, so far, little actual participation.
The share of firms offering high-deductible policies to workers doubled to 20 percent from 2004, but only a small fraction -- covering about 2.4 million workers -- have taken the additional step of providing a health care reimbursement account or a health savings account to encourage workers to shop.
"There absolutely is growing interest in consumer-driven arrangements," Altman said, but with the small number of workers enrolled in them, "it's impossible to make a judgment about their effect on health care cost."
"It's not that the jury is still out on them. The jury hasn't convened yet," he said.
In the meantime, the "preferred provider organization," in which there is a network of doctors, hospitals and other health professionals who have agreed to provide care for a set price, increased its lead as the dominant form of employer plan.
Family coverage under a PPO cost an average of $11,090, with the employer paying $8,449 and the worker $2,641, making such plans not only the most popular -- covering 61 percent of employees, up from 55 percent a year ago -- but also the most expensive.
Health maintenance organizations, though cheaper at $10,456 for a family, divided on average at $7,852 for the employer and $2,604 for the worker, showed a decline in enrollment share to 21 percent from 25 percent.
