卫生保健 Costs and Your Employee Health Plan

医疗费用, and consequently employee health benefits costs, have been increasing at an alarming rate for nearly a decade. Avoiding rising health care costs is nearly impossible, 但你可以从中了解成本持续上涨的原因，以及你可以做些什么来管理你的组织和员工的成本.

协助您, this article explains factors leading to continued rate hikes, 最新的医疗保健成本数据和美国各地的企业正在实施的帮助管理成本的策略.

Factors Leading to Increased 卫生保健 Costs

你为什么.S. 医疗费用飞涨? Several market conditions have led to a decade of unrelenting increases. Factors that have contributed to climbing health care costs over the past decade include:

• 人口统计资料
• 扩大保健服务提供者
• Consolidation of managed care companies
• Political environment and government regulation
• Increased utilization and consumer demand
• 新医疗技术
• 管理式医疗体系弱化
• Health care spending and medical cost inflation
• 处方药成本增加

以下两个因素也会增加当前和预计的医疗保健费用.

人口老龄化

Because older workers are more prone to health problems, companies are seeing a rise in chronic conditions, costly medical problems and the use of prescription drugs, as well as an increase in the amount and frequency of catastrophic claims.

整体健康欠佳

Poorer health among Ameri可以s has also contributed to health care cost increases. 肥胖和高血压等可预防的风险因素导致糖尿病和心脏病等慢性疾病的增加，这些疾病是长期的，代价高昂. 不健康的生活方式可以通过健康计划来改善员工的健康并降低成本, but most savings are seen in the long term. To combat the continuing short-term increases, employers are passing more and more costs to employees through higher deductibles, copays and out-of-pocket maximum amounts.

了解为什么你的年度健康计划更新率可能比前一年明显高得多，这是针对你的特定计划的挑战形成替代方案和解决方案的关键. 同样重要的是，要让你的员工了解你可能决定引入的任何计划或贡献变更背后的原因.

雇主能做些什么?

Employers are struggling to contain accelerating health plan costs. After trying to absorb most of the costs because of hiring and retention issues, many firms are attacking the root causes of rising costs with sustained, 系统性变化. 随着健康状况不佳的日益流行以及医疗改革的总体影响不确定, many employers are looking at both short- and long-term strategies to manage costs.

Using 卫生保健 Data to Drive Strategy

翰威特咨询公司(Hewitt Associates)的一项调查发现，雇主将利用医疗数据制定战略性医疗计划作为削减成本的首要策略. 然而, the survey also discussed the importance of going beyond accessing data, and understanding how to apply it when making decisions and implementing strategic changes.

Greater Emphasis on Consumer Driven plans

在医疗保健行业，越来越受欢迎的选择是采用消费者驱动的健康计划, typically involving a health reimbursement account (HRA) or health savings account (HSA). These plans offer cost-savings for the employer, but also benefit the employee. 接受适当的教育, employees 可以 become smarter health care consumers, 这样可以为双方省钱.

Promoting Employee 健康与福利

健康和保健举措已成为另一种流行的医疗保健成本管理策略, and remain one of employers’ top cost containment strategies. 越来越多的雇主意识到，改善员工的健康状况可以降低医疗成本，提高生产力, many are creating more comprehensive programs, targeting specific diseases and including dependents in the initiatives.

参与激励也越来越受欢迎(包括对家属的激励)。, but it is important to use effective incentives. 奖励参与项目或达到健康目标的员工比激励完成健康风险评估等事情要有效得多. Many employers are also instituting penalties for nonparticipation or unhealthy behaviors, often in the form of higher premiums or additional employee cost sharing. 值得注意的是，成功的健康和疾病管理举措依赖于高质量的员工教育和沟通技术.

增加员工成本分担

许多雇主选择将更多的成本转嫁给员工，或者重组他们的健康计划，以激励员工选择成本更低的方案. These are a few strategies employers are using:

• 从固定金额的共同支付转向共同保险模式(雇员为每项医疗保健服务支付一定比例的费用)
• Increasing deductibles and out-of-pocket maximums
• Increasing employee cost sharing for out-of-network providers
• 增加品牌处方药的员工成本分担，以激励非专利药的使用
• 提供消费者驱动的计划, either as an option along with a traditional plan or as a total replacement

依赖管理策略

雇主们通过改变管理家属的方式，发现了巨大的节省成本的机会. 受抚养人资格审核 可以 save companies substantial amounts of money. 研究表明, 平均, 5% to 15% of dependents are actually not eligible to be on the health plan. Many companies are also shifting to a per-member premium structure, rather than just “individual” and “family.另一个正在出现的趋势是要求配偶支付更多的保费或征收附加费，以鼓励配偶加入自己雇主的保险计划.

策略性供应商管理

最近的一项运动涉及公司积极评估他们的供应商关系，并取代或消除那些不能产生可衡量结果的供应商. 雇主们也在寻找机会巩固与供应商的关系，以最大限度地利用他们的钱.

长期解决方案vs. 短期修复

Due to the financial pressure many employers are under, short-term tactics like employee cost sharing are still prevalent. 然而, 雇主们正在探索多年计划和长期举措，以改善员工的整体健康状况，并在未来对成本进行战略性管理. Particularly in the wake of health care reform, 许多雇主越来越关注开发可持续降低成本的策略.

哪种解决方案适合您?

Should you pass costs on to employees? Or should you try to manage costs in some of the other ways discussed in this article? 最终, 这是一个决定，你需要经过深思熟虑和详细的分析你的计划，并与你的经纪人或顾问的建议.

下面是一些你可以解决的问题，以便开始制定适合你的组织的有效策略.

• Is our program structure, plan design and pricing appropriate?
• Do we have the right vendors, services, contracting and funding in place?
• Are our employee communication efforts appropriate and effective, especially regarding employee health and wellness and/or consumerism?
• Do we have effective disease management and wellness programs for our employees?
• 我们的定价和计划设计功能是否鼓励了员工的成本意识行为?
• Are we thinking about long-term solutions rather than quick fixes for this year?

我应该告诉我的员工什么?

医疗费用 continue to increase at exceptionally high rates from year to year. You want to continue to offer valuable health benefits to your current employees, and you want those benefits to help you attract and retain quality employees. 然而, 你还需要考虑这些福利的成本效益，因为目前大幅加息已成为常态. 

  本文中包含的信息旨在帮助您了解续订费率可能增加的原因, 并帮助你教育你的员工，让他们了解你可能不得不做出任何计划或贡献改变的原因. If your employees understand current trends in the health care industry, 他们将更加支持变革，并将感激为他们提供保健福利所需的资源.

For more information on how to communicate health plan changes to employees, contact 桑福德 & Tatum, An Alera Group Company today.

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