As if a sluggish economy isn't bad enough, health-benefit costs are also putting pressure on U.S. companies.

According to a new survey by Mercer Human Resource Consulting, worker health-benefit costs rose by nearly 15% this year, representing the largest increase since 1990. (Note that inflation during the same period was a mere 2%.) Worse, the poor economy is making it extra hard for companies to cope with the rise in health-care costs.

Since these are typically costs paid for primarily by employers, employees often ignore them. Pay attention now, though. With such significant increases (a further 2003 increase of 13% is expected by many), some big changes are afoot. Many companies will be either unable or unwilling to continue footing these bills. Don't be surprised if your copayments and deductibles increase, for example. Your raises and other benefits might shrink, too.

Hardest hit are small- and medium-sized companies, some of which might consider eliminating health-care coverage altogether. Larger organizations have more bargaining power and enjoy more discounts that can be passed on to employees. According to Mercer, 62% of small employers now offer health insurance, down from 66% just a year ago. The Mercer survey found that the average 2002 cost increase was 11.5% for companies with more than 500 employees, and a whopping 18.1% for firms with fewer than 500 workers. According toTheWall Street Journal (subscription required, free trial available to Fools), "The average employee is costing his employer $5,646 this year in health costs, up 56% from $3,594 only five years ago."

Some companies are taking matters into their own hands, instituting in-house medical coverage. BusinessWeek recently described several such occurrences, such as the printing company Quad/Graphics, which now has doctors and nurses on its payroll of around 8,000 employees. The company's health plan is proving popular and saving the firm more than $6 million per year.

What's a Fool to do? Well, be prepared for things to get worse before they get better. At this rate, they'll likely get so bad that something has to be done, perhaps via legislation.