WATERLOO - In an effort to hold down health care costs in a struggling economy, a survey released this week found Iowa employers asked its workers this year to pay more insurance costs and improve personal health.

Even with more people paying higher deductibles and leading healthier lifestyles by enrolling in programs such as smoking cessation classes, costs increased nearly 5 percent, or $8,458 per employee, according to an annual survey of 72 Iowa employers by Mercer, a national consulting firm.

To lower expenses, small employers often raised deductibles and shifted employees to health savings accounts, while large employers largely relied on programs and policies designed to improve employee health.

"I think employers are really taking time to look at their plan designs, and see how it sits with their company philosophy and see if they can hold the line on costs. For them, it truly is a balancing act," said Angela Villhauer, a Mercer spokeswoman based in Cedar Rapids.

The cost control efforts have paid off, the report found. Health benefit costs increased 5.5 percent, the lowest in a decade. However, pocketbooks remain strained as costs outpaced inflation by a widening margin, Villhauer said.

Employers nationwide expect a similar cost increase in 2010. The study found employers predict a 9 percent increase in current health plan costs. However, with adjustments they hope to lower the increase to around 6 percent.

However, Julie Heidt, a health insurance agent at Sinnott Agency in Waterloo, said many of the small employers she works with saw higher cost increases than usual this year. She said rates most often increased around 9 to 13 percent for employers.

"The biggest thing they're doing is increasing their deductible, or co-pay, unfortunately passing along that increase onto employees," she said.