With anger over runaway costs boiling over, business and labor leaders who spoke yesterday at dueling health care summits in Allegheny County called for dramatic reforms including financial penalties for doctors and hospitals who provide poor care.

At a Downtown conference co-sponsored by insurer Highmark Inc. and a California think tank, the chief executive of the region's largest insurer blamed the cost increases on the usual suspects, ranging from medical malpractice to expensive new technologies that sometimes provide little improvement for patients. The aging of the population and unhealthy lifestyles that lead to obesity and cancer play roles, too, said Dr. Kenneth Melani.

But Dr. Robert Brook, vice president of Rand Corp. and director of its health care research, largely took aim at the medical community itself, charging that providers have resisted the kind of performance measurement that other industries use. The result, he said, is they have perpetuated care that too often is of poor quality or completely unnecessary.

That point was amplified at a summit across town in Churchill, where Cliff Shannon, president of SMC Business Councils, charged that Pennsylvania businesses and individuals who buy insurance or health care on their own pay hundreds of millions of dollars each year for services that injure or kill patients. They end up paying even more to fix the problems, Shannon told about 100 business and labor leaders at the Pennsylvania Health Care Cost Containment Council conference.

Shannon advocated not just "pay-for-performance" programs that reward quality, but also an end to efforts to cap medical malpractice awards for pain and suffering. Such efforts are "a waste of time," Shannon said, breaking ranks from business groups that traditionally have supported tort reform efforts.

Shannon also called on Pennsylvania's state government to follow the lead of other states in actively helping state residents re-import cheaper prescription drugs from other countries.

Both summits addressed the same central problem: Health care costs have boosted employers' health benefits costs by an average of 59 percent nationwide in the past four years.

Managed health care plans, which began rolling across the country 15 years ago and became the dominant form of employer-sponsored health insurance in the region in the mid-1990s, brought temporary relief from surging premiums.

But the latest bout of double-digit increases have led many corporate benefit analysts to peg health plans that encourage higher quality medical care, healthier lifestyles -- or both -- as the last options at their disposal for curbing costs.

Melani said rampant malpractice claims spur unnecessary care by causing doctors to practice defensive medicine. Consumer demand, in part stimulated by advertising of new drugs and treatments, also contributes to higher costs, he said.

Brook, however, eschewed the laundry list of factors many in medicine cite for rising costs, arguing instead that the biggest problem in health care is poor quality and unnecessary care, driven largely by hospitals and doctors who resist performance measurement out of their desire to "take the last dollar out of the system."

As an example, Brook, a medical doctor himself, cited a conversation with a cancer specialist in California in the wake of the federal government's proposed cuts in Medicare's reimbursements for chemotherapy drugs. The specialist, described by Brook as one of the best oncologists in Los Angeles, told him the cuts likely would spur more use of radiation therapy "because we have to replace the revenue somehow."

Brook maintained that the cuts in chemotherapy drugs were proposed because, "the government realized this was a racket" in which Medicare was paying far more to doctors for the drugs than the medicines actually cost them. Oncologists have argued that they need the rich payments for the chemotherapy medicines because they aren't adequately reimbursed for other services they provide to cancer patients.

The lack of information on the outcomes of medical treatments and other quality measures reflects resistance in the medical community, he argued. He said there needs to be "a revolution in disclosure" before there can be any hope of taming health care costs.

At the Churchill summit, Marc P. Volavka, executive director of the state's cost containment council that's responsible for addressing issues of costs and quality, provided one example of the data sought by reformers.

The council began collecting data on hospital-acquired infections in January, and numbers from the first quarter -- while imperfect -- begin to show the cost of poor care in terms of dollars and sickness, Volavka said.

"People are already paying for performance, it's just that in too many cases they're paying for poor performance," he said.