Debating the Impact of High-Deductible Health Plans

"This is not to suggest we think these plans are bad," he added. It's just that "these plans are not enough" to rein in health-care costs.

Merrill Matthews Jr., director of the Council for Affordable Health Insurance, which favors consumer-driven plans, said he disagreed with some of Watson Wyatt's findings.

The very sick who have big claims on their high-deductible policies indeed do "move back into the same old insulation from cost, but that's what you wanted insurance to do," protect you from catastrophes, Matthews said.

But he said there is more opportunity to influence outlays by individuals in the middle -- the remaining 24 percent who account for 40 percent of costs -- than the study suggests.

However, in Watson Wyatt's view, the greatest impact on costs comes from other changes in employers' approach to health care. This means using a number of programs and focusing them on the segments of the workforce where they will be most effective.

At one end of the scale, it means looking at health improvement and productivity together. Many employers view issues such as absenteeism as separate from health care, "and we know those kinds of things are related," he said.

It also means trying to keep healthy workers healthy -- encouraging smoking cessation, weight loss and other steps toward healthier ways of living.

At the other end of the scale, it means health plans that guide sick workers to cost-effective doctors, hospitals and other providers.

It also includes directing those with severe illness or injury to high-quality treatment facilities.

Nussbaum noted that high-quality treatment can often bring about major cost savings even though such providers' fees may seem high. This is because such treatment typically results in lower rates of infection, fewer readmissions to hospitals, and the like, and shorter recovery times. When all this is taken into account, seemingly expensive doctors and hospitals often produce big savings.

"In some areas of the country, using high-quality care centers may cut [insurance] plan expenditures for the most expensive cases in half," Nussbaum said.

Among the companies in the study, the two-year growth in health-care costs ranged from 3 to 11.5 percent, with the average coming in at 8 percent. The firms with the lowest rise tended to be the ones that were applying all the different strategies and adjusting them as they go along.