For a decade, Baptist Health South Florida has been a leader in urging its 13,000 employees to lead healthier lifestyles — offering such benefits as free 24/7 gyms at work and discounted low-fat meals in the cafeterias.

When it came to choosing the carrot or the stick for promoting wellness and reducing skyrocketing healthcare costs, Baptist has offered the carrot. Many major employers are making similar moves elsewhere in South Florida and around the country.

But now Baptist and others say those efforts may not be enough because healthcare costs have continued to rise. That has prompted some companies across the country to reach for the stick — for example, finding ways for employees with unhealthy habits to pay more for insurance.

Baptist isn’t among them. Instead, it has decided to offer even more carrots. Starting in about a year, Baptist will offer incentives to high-risk employees and relatives, says Corey Heller, the system’s chief human resources officer. Details are still being worked out, but the basic concept is that those with chronic problems would be rewarded for trying to deal with them — for example, reducing premiums for overweight workers who regularly exercise in a gym or meet certain weight loss goals.

Many employers nationwide also are thinking along the same lines, although it’s not clear which approach — reward or punishment — will prevail.

A national survey of 600 major companies by the Towers Watson consulting firm found that 33 percent were planning in 2012 or later to reward or penalize workers based on targets for such issues as weight and cholesterol levels.

Another 18 percent plan in 2012 or later to take similar actions when it comes to those with chronic diseases. That’s double the percentage of major companies that were enforcing such measures in 2010.

Facing a national obesity epidemic and soaring numbers of diabetics, many employers are worried about rising healthcare costs. Though double-digit percentage increases are no longer happening, a recent survey of 100 Florida employers by the Mercer consulting group found that their total healthcare costs increased 5.7 percent in 2011 — two-thirds higher than the inflation rate of 3.5 percent. Healthcare costs at Florida companies that offer insurance now average $9,093 per employee annually, the Mercer study found.

Baptist, with all its wellness initiatives, saw employee healthcares costs rise 14.6 percent in 2010 and another 5.7 percent in 2011.

Wellness is on many executives’ minds. Two-thirds of employers in the Towers Watson survey said they feel their main challenge to affordable healthcare is the poor health habits of their employees.

The easiest move for many employers appears to be taking action to cut down on smoking. Baptist gives its nonsmokers a carrot, a $30 reduction in premium payments per biweekly pay period. Florida Power & Light offers a $5 biweekly reduction for nonsmokers. The University of Miami employs a stick — a $50 monthly fee tacked onto premiums for smokers. All three employers rely on workers to volunteer honest answers and all provide free smoking cessation programs.

Many surveys indicate that the real healthcare costs of a smoker are far higher. One study from the Centers for Disease Control and Prevention estimated that the average smoker costs an employer $1,600 in additional medical expenditures and $1,760 in lost productivity each year.