As the price of health care continues to spiral upward, many of the nation's largest employers are looking for ways to contain the escalating costs of health insurance premiums, and most are considering passing the buck to their employees.

According to a study sponsored by the journal Health Affairs, almost all of the Fortune 500 companies are concerned that there are few cost-cutting alternatives to consider with the almost universal use of managed care plans.

This lack of options, combined with rising prices, has pushed many employers to use tough negotiating techniques to keep prices down and avoid passing the costs to their employees. It is a trend that may have serious implications for the overall quality of care.

However, as businesses have become more successful at exerting price pressure on their health carriers, those carriers have in turn cut their payments to hospitals and doctors. According to James Maxwell, director of health policy and management research at John Snow Inc. Research and Training Institute, it is unclear whether health carriers can continue with these kinds of cost-cutting measures without endangering the quality of patient care.

Furthermore, the quality of clinical care is an area that has also been largely ignored by the employers themselves. According to the study, while 83 percent of the employers surveyed reported using quality as a consideration in selecting a carrier, only 32 percent of those set specific standards regarding the clinical quality provided by their health insurance contracts.

"Clinical quality efforts generally require more cost and effort, so companies often neglect these in favor of more easily measured quality indicators, such as customer service," says Maxwell.

As large companies are unable to find other methods of reducing the cost of health care, they are passing the higher prices on to workers.

What makes this trend so dangerous is that, increasingly, as large employers are unable to find other methods of reducing the cost of health insurance, they are passing the higher prices on to workers. Between 1994 and 1999, the number of companies that paid all of their employees' health care premiums had dropped by 50 percent.

In short, companies want their employees to take on more responsibility for their own health care, even though employers are either not collecting or not sharing information about the clinical quality of that care, says Maxwell.

As the Fortune 500 paved the way for managed care, those same companies may set the standard for employer-sponsored health care in the future. The question lies in whether or not the business community will continue to cut costs and corners, jeopardizing the quality of care, or if they will turn to more innovative solutions.