More companies are responding to the escalating cost of health care by involving their employees more in the process.

"There's a shift to consumerism in health care," says Tim Schmidt, a partner at Lurie, Besikof Lapidus & Company, a Leading Edge Alliance firm. "Employers are having to share (the cost) with employees. They can't absorb it all.

"The costs need to be shared more and companies have shifted more of the responsibility to employees."

Lari Braun, human resource manager of Henry & Horne, a Leading Edge Alliance firm, agrees with Schmidt. She says that offering health care benefits still is expected by most employees.

However, companies are working more to inform their employees of factors affecting health care and related costs than they have in the past. "It's a wellness aspect and it's employee education. There's tons of information," Braun says.

"There's been a shift to consumerism-shopping for physicians, pharmaceuticals and hospitals," Schmidt says.

A recent study by the International Society for Certified Employee Benefits Specialists and Deloitte Consulting LLP supports that. Of the nearly 350 survey participants:

• 90 percent say controlling health care benefit costs is their No. 1 priority.
• 83 percent say they increased or planned to increase employee cost-sharing in health and welfare programs.
• 72 percent increased the emphasis on consumerism for employee health and welfare programs.
• 85 percent have or will focus on increasing employee communication and education efforts.

Braun says that part of the education at her firm is making sure employees understand when they should see a doctor rather than rushing to the emergency room for a non-emergency. "We also stress that the reason for health insurance really is not day-to-day health care but for catastrophic events," she adds.

Employees also are given more details about plan options, total costs and benefits, Braun says. During open enrollment periods, employees are given a spreadsheet detailing that data, which is available year round on the Internet.

"They appreciate knowing the value," Braun says, noting the participation rate in the plan is high.

With a greater understanding of their benefits, employees are taking a more active role in consciously making health care decisions. For example, when Henry & Horne raised the co-pay for the pharmacy benefits, more employees considered the benefits of using generic drugs than had done so in the past.

With health care costs escalating across the board, there are not a lot of vehicles to take out the bite, Schmidt says. However, there are options that allow the company and the employees to make a decision in how they want to pay for health care. Cafeteria, flex, HMO, and high-deductible plans are a few of those options.

Beginning Jan. 1, 2004, Health Savings Accounts (HSAs) may be set up to allow individuals and employees, through an employer's cafeteria plan, to make pre-tax contributions of up to $2,600 annually ($5,150 for families) to cover health care costs, to high-deductible health insurance plans. Money put into an HSA used by a beneficiary for qualified medical expenses is not included in that person's gross income. A high-deductible health plan is one that has at least a $1,000 annual deductible for individuals, and a $2,000 deductible for family coverage. In addition, annual out-of-pocket expenses paid under the plan must be limited to $5,000 for individuals and $10,000 for families. Such expenses include the deductibles, co-payments and amounts other than the premiums that must be paid for plan benefits.

"They're a more attractive savings/tax feature than the Medical Savings Account (MSA), which was rarely used and frequently cumbersome," Schmidt says.

In the long run, he says, some companies may get out of the health care business. Instead, they will offer employees a set annual amount for health care and allow the employees to go on the open market and pick their own plans. e