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The last option seems to be the best way to encourage people to make more efficient use of their health plan. High-deductible plans require employees to pay 100% of claims after a certain point, rather than just co-pays. Ultimately, they may not have more out of pocket expense, but the thought of paying $150 for that bottle of pills may encourage them to ask if a generic version is available. Paying the doctor $250 for a 15-minute appointment because of a cold could deter them from making unnecessary visits.

In addition, employers can let employees carry over portions of the deductible that they don't use to protect them at a time when they have a major need for services. HSA accounts even let employees take away what they don't use, just like a 401K plan. Coupling it with a 125 Plan to reduce their tax bills makes this an attractive plan to offer if you want to get control of costs.

Those of you still unable to secure coverage due to the size of your company could try to buy a plan or policy to cover catastrophic claims, keeping the burden of everyday costs with the employees.

There is no easy answer. However, looking at the HRA and HSA plans is a must. Educating employees is a must. Offering incentives for efficient use of premium dollars is a must. And making health care cost management a priority is most certainly a must.

Garry Bartecki is director of dealer/distributor services at BDO Seidman, LLP of Chicago, as well as a consultant to the AED. He has also worked as an independent CPA and consultant to equipment dealers. He can be reached at (312) 616-4677 or gbartecki@bdo.com.