Despite rising health care costs and other economic worries, a majority of large U.S. employers remain confident they will continue to offer health care benefits to workers 10 years from now. However, the level of confidence has slipped from last year due to economic concerns and uncertainty over the implications of potential health care reform, according to a new survey by Watson Wyatt, a global consulting firm, and the National Business Group on Health (NBGH), an association of more than 300 mostly large employers.

The survey of 489 large U.S. employers, conducted in January 2009, also identified a group of "consistent employers" that have maintained a long track record of lower health care cost increases over the past four years. These employers have outperformed other employers in five key areas: appropriate financial incentives, effective information delivery, quality care, metrics and evidence, and maximizing health and productivity.

According to the survey, 62 percent of employers are very confident they will continue to offer health care benefits 10 years from now, down from 73 percent last year. The survey also found that, despite today's economic uncertainty, roughly four in 10 employers (41 percent) are sticking with their current health care strategy, while the remaining respondents have either revamped their strategy or expect to do so this year.

"This is the first time in the 14 years that we have conducted this survey that employer confidence has declined, and it is not related to an increase in cost trends," said Ted Nussbaum, North America director of group and health care consulting at Watson Wyatt. "This clearly reflects the uncertainty among large employers over the impact that the fragile economy is having on their ability to stay competitive in the face of health care costs that persistently rise at double the rate of general inflation."

The survey found that employers do not support most of the commonly prescribed solutions to the issues that plague the health care system. More than two-thirds (68 percent) are very or somewhat supportive of reforms that advance the consumer-oriented model and emphasize greater individual responsibility. Respondents are least in favor of tax policy changes that remove tax deductibility of employer premium contributions, with only 12 percent supporting those proposals.