Recent studies by Towers Perrin and Hewitt Associates both project 2009 health-care cost increases to be around 6 percent nationally. Although that is less than the double-digit increases we've seen in recent years, 6 percent still may sound like a lot.

I don't blame people for wondering, perhaps angrily, why health-care costs continue to rise. As a local executive for a national health insurer, however, I know that there are real, structural reasons these costs increase every year, and that addressing the causes of health-care inflation is a daunting task.

A big part of the increase in health-care costs this year is inflation, which most experts say will run 5.6 percent, fueled by the dramatic increase in energy costs for much of the year. When you take overall inflation into account, the real increase in health care is minimal.

Besides inflation, there are a number of trends that continue to drive health-care costs up, despite the best efforts of employers, consumers, health-care professionals and insurance companies to cut them:

• Unhealthful lifestyles. There continues to be an increase in conditions such as diabetes, heart disease and some cancers related to unhealthful lifestyles and obesity. The total bill for delivering health care in our country would decline dramatically if more Americans adopted healthful habits.

• An aging population. The population is aging, and the elderly tend to need and use more health-care resources. Because of its older demographics, the aging of the population affects Allegheny County more than most other places.

• The economy. Several studies have shown that many people with chronic conditions stop taking or take smaller doses of medication or forgo other care because they can't afford it. This results in greater overall costs when patients deteriorate and need more expensive treatments.

• Use and overuse of medical technology. New technologies improve medical care but also drive up the cost of caregiving. For example, in what has become known as the "medical arms race," many medical practices invest in expensive imaging machines, and once a group owns one, there is a tendency to use it more rather than refer patients to lower-cost facilities.

It will be a challenge to slow or reverse these trends in the short term.

There are, however, some actions that employers and employees can take today to "act locally" and reduce the cost of their health care. For example, businesses can offer employees incentives to shift to the combination of a high-deductible health plan and a health savings account. A recent study of employers offering UnitedHealthcare plans indicated that an HSA program provides a 10 to 12 percent cost savings over a four-year period, in part due to greater use of preventive care.

Employers can encourage workers to use generic drugs, which usually have the same components as brand-name drugs but cost less. And employers can study employees' usage of benefits to identify and provide wellness programs to address the most prevalent issues.

There is no quick solution, but employers can take action to help lower the cost of health care. And in the process, employers and their employees will play an important role in making quality health care more affordable and accessible for all.