Two of the somber realities of economic life, recession and high health-care costs, are coming together at just the wrong time for many businesses and employees.

Consulting firms are recommending that companies scrutinize their plans for savings, but the historical evidence shows that insecurity and other stresses of economic downturns produce greater demands on the plans."For a variety of reasons, health-care utilization and lean times go hand in hand," says Anna Rappaport, an officer of William M. Mercer Inc., a leading employee benefits and human resources consulting firm.

Even layoffs, inevitable in a recession, can have an impact on the cost of health coverage, since the Consolidated Ominibus Budget Act of 1985 requires employees to offer continued coverage to terminated workers.

Health-care managers believe some of those former employees may use their time to attend to nagging ailments or to undergo surgery they had postponed, or that financial stress could produce costly physical and mental problems.

While the Omnibus Act (popularly and perhaps aptly known as COBRA in some circles) allows employers to charge terminated employees the full cost of continued coverage, the companies still could end up with higher costs.

Rappaport explains that employees who continue coverage often are those most in need. Typically, she says, that need might involve someone in the family with a mental or physical ailment, with the result that their coverage costs more than the company is allowed to charge the former worker.

Still another recession-induced problem puts pressure on company benefit plans: Older workers and those with chronic ailments may seek protection from termination by opting for early retirement or by filing a disability claim.

Consultants at Mercer, which serves 9,000 domestic employers, and more if its international operations are included, are urging clients to re-examine their plans and prepare for the worst but to avoid knee-jerk solutions.

Based on past experience, one of the more serious blunders may be to slash benefits at the expense of morale and productivity. Rappaport, a Mercer managing director, claims that to do so "can send all the wrong signals."

Instead, she recommends that companies seek to preserve the overall value of benefits, and that if it is necessary to shift costs to employees then it is also wise to balance this with a low-cost addition to the plan.

Health-care costs have been a worsening problem for more than two decades, consistently rising faster than inflation in general. By some estimates, health care now accounts for about 17 percent of gross national product.

At the same time, recipients, providers, insurers, employers and others agree that much cost is associated with correctible personal habits, waste, duplication and needless usage, such as overly long hospital stays.

One of the most disturbing consequences of efforts to correct any one of these, however, has been to see costs rise in another area. Savings were sought, for example, by avoiding or limiting hospital stays, and it worked for a time. But out-of-hospital costs then rose and negated some of those efforts.

In view of such experiences, Rappaport believes there is "no clean, neat solution." Instead, she says, the problem must be attacked in whatever new ways it rears its ugly head. "There are tradeoffs but not solutions."