It's an ill wind that blows: as the economy winds down, the cost to business for providing health coverage keeps spiraling up.

• Position: HEALTH CARE

Health-insurance costs for U.S. employers are rising--by about 6% this year, according to one consulting firm--and care is still hard to find in some parts of North Carolina. Hospitals compete fiercely for patients in places with affluent, fast-growing populations but shun many rural parts of the state. And the quality of care isn't always what it should be. Haywood Regional Medical Center in Clyde temporarily lost federal Medicare and Medicaid reimbursements in 2008 because of faulty procedures for dispensing medications, and other Tar Heel hospitals endured uncomfortable examinations of their practices. Bob Greczyn is CEO of Blue Cross and Blue Shield of North Carolina, the state's largest health insurer.

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BNC: What effect will the recession have on health care?

Greczyn: We're seeing layoffs. When people get laid off, they often lose their health-care coverage. Hopefully, we'll see the economy turn around after the middle of this year.

When will the cost spiral stop?

There's a structural annual cost increase built into health care because of new technology, the aging of the population and new treatments. Part of what's going on is that employers are trying to continue to offer coverage, balancing between how large the co-pays or the deductibles are versus the total cost of the benefit plan. I don't see that changing in the near term.

Do you foresee mandatory wellness plans to get employees to manage their health better?

It's hard to make it absolutely mandatory. At Blue Cross, in order to get a portion of the employer contribution to your health-care coverage you have to go through a medical screening and engage in a wellness activity--pretty much anything--and you have to fill out a health-risk assessment form. We're strongly encouraging people to improve their health. Employers have an important role to play.

The large health-care systems seem to be getting larger.

I don't really see consolidation slowing down, but some of these large health-care systems are putting off construction projects. A lot of that is due to their inability to get bond financing.

How do you respond to consolidation?

One thing we're trying to focus on is a project with the North Carolina Center for Hospital Quality and Patient Safety and the North Carolina Hospital Association to make the state's hospitals the safest in the U.S. over the next few years. We're also focusing on what we call centers of excellence, a designation we give to...