Shifting Risk, Responsibility

His wife is due around Christmas, and he is happy he stayed. On Fridays he works from home to spend more time with their 2-year-old daughter.

Health-care benefits are an increasing concern among workers, though managers do not seem to realize just how big a worry they are.

In a recent survey by Watson Wyatt Worldwide Inc., a benefits consulting firm, no employer thought health-care coverage was a key reason top performers leave. When top-performing employees were asked the same question, 22 percent said they would consider leaving if coverage was lacking or too expensive.

"The job market is booming," said Jane Weizmann, a senior consultant with Watson Wyatt. "When you look at it that way and think of health care as a satisfier or dissatisfier, you think, 'If I have to pass higher costs on, how do I package that and make sure the deal feels balanced?' "

Some companies, such as Marriott, are offering free preventive care to take the edge off higher health costs. This approach works toward two goals: The employee sees a bonus, and it helps improve employee health, which may in the end help cut the costs of health care.

Marriott employee health-care costs have risen about 5 percent this year, according to Jill Berger, vice president of health and welfare benefits.

Stephanie Hampton, a company spokesman, is due to have her second child after Christmas. This time around, because of Marriott's Active Health Management program, she has not had to pay anything for her pregnancy appointments. The program is still growing and is not yet offered to every employee. "We're trying to get it everywhere," Berger said.

Employees with chronic conditions, or conditions that can be managed, such as pregnancy, diabetes or heart disease, don't have to pay for regular appointments related to those conditions. The assumption is the more the employees go for preventive care, the fewer expensive hospital visits and longer-term health conditions they will have.

In addition, drugs related to those conditions are free.

"If you have a chronic condition," Berger said, "one of the problems that we identified is compliance. A lot of drugs every month and co-pays add up. So if that becomes a barrier, people might stop taking it."

Many companies are turning to their employees to make the right health choices to keep everyone's cost down.

In some cases, employees get incentives to complete health risk appraisals and to use generic drugs.