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Why Employers Struggle to Manage the Cost of Their Employee Health Benefits—and What Might Help: A Policy Brief on Cost Control in Self-Insured Employer Health Plans

RAND | 2026-08-24 | health

Topics: United States

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English Summary

Employers face significant difficulty controlling rising costs in self-insured employee health plans due to structural market barriers. Key challenges include opaque and complex vendor fees, misaligned incentives among third-party administrators (TPAs), and limited negotiation leverage for many employers. To address this, the report suggests that policy intervention is needed, recommending either federal mandates for fee transparency and TPA fiduciary accountability, or encouraging employers to bypass traditional TPA arrangements entirely. Ultimately, effective cost control requires systemic reforms to improve data access and align financial incentives across the health benefit ecosystem.

中文摘要

由於結構性的市場障礙,雇主在控制自負員工健康保險計畫的成本增長方面面臨重大困難。主要挑戰包括供應商費用的不透明與複雜、第三方管理機構(TPAs)之間利益誘因不一致,以及許多雇主缺乏談判籌碼。為了解決此問題,本報告建議需要政策層面的介入,主張實施聯邦強制規定以確保費用透明度及TPA的信託責任,或鼓勵雇主完全繞過傳統的TPA安排。最終而言,有效的成本控制需要系統性的改革來改善數據存取權限並協調整個健康福利生態系統中的財務激勵機制。

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