Purchasers are increasingly requiring health plans to focus on the quality of health care delivered to consumers, according to the National Business Coalition, which says that more health plans are reducing barriers to essential treatments. For example, 27 percent of plans are waiving copayments for diabetes drugs and 33 percent have reduced copayments… Low Medicare and Medicaid payments to hospitals and physicians lead to significantly higher insurance costs for consumers and employers, according to a study by Milliman. The study found that annual health care spending for an average family of four is $1,788 higher than it would be if Medicare, Medicaid, and private insurers paid hospitals and physicians at similar rates. Government payers tend to underpay hospitals and physicians. This creates a payment gap that privately insured employers and consumers must close through cost shifting, which is the difference between actual payment rates and average payment rates… Nineteen percent of employees are willing to pay higher premiums in order to keep deductibles and copayments lower and more predictable, says a survey from Watson Wyatt. Last year, though, 38 percent chose the higher premiums. Some workers are taking actions that could lead to higher costs in the future. For example, 17 percent reported that they avoided a recommended doctor’s visit this year to save costs. Similarly, 17 percent did not fill a prescription or skipped doses of prescribed medications, an increase from 13 percent in 2007.