An absence of accountability: Evidence of employers’ failure to measure and manage employee health benefits administration
Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and...
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| Published in: | Social science & medicine (1982) Vol. 377; p. 118131 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
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Elsevier Ltd
01.07.2025
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| ISSN: | 0277-9536, 1873-5347, 1873-5347 |
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| Abstract | Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers’ responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health.
•Employers are doing an inadequate job of measuring and managing health benefits.•64 % of 15 health benefits performance dimensions were managed by no one.•39 % of companies never requested any employee feedback about health benefits.•Lack of accountability is inconsistent with employer responsibilities for benefits.•This affects employees access to care and satisfaction with plan administrators. |
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| AbstractList | Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers' responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health. Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers' responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health.Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers' responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health. Because employers provide health benefits to >50 % of the working age U.S. population, benefits managers at companies who purchase and potentially oversee design and delivery of health benefits have an important role in affecting healthcare delivery. We sought to assess how companies measure and manage health benefits, because these dimensions of accountability affect the performance of the health ecosystem. We randomly sampled companies and obtained data from >200 people knowledgeable about health benefits administration in their organizations. Our novel survey comprehensively inquired about what data concerning health benefits operations companies collected and who, if anyone, was responsible for aspects of employee benefits experience and outcomes. We found a surprisingly small amount of accountability for employer-provided health benefits. For instance, 39 % of companies never requested any feedback from their employees about their health benefits, just 6 % assessed the time employees spent getting questions about their health benefits answered, and <5 % of companies measured how often employees postponed filling a prescription or seeing a doctor because of cost. Moreover, there was a widespread absence of accountability for the performance of health plans. On average, 64 % of 15 health benefits performance dimensions were managed by no one, and more than half of respondents reported that no one in their organizations was held accountable for either the physical (64 %) or emotional (59 %) wellbeing of the workforce. Companies mostly provide minimal oversight of the health plans they provide to their employees. This lack of accountability is inconsistent with employers’ responsibilities to effectively manage the benefits they provide and almost certainly contributes to the well-documented problems of employee dissatisfaction with third party health benefits administrators and the frustration and wasted time spent accessing care and reimbursement that occasionally results in care delayed or denied, with consequences for both behavioral and physical health. •Employers are doing an inadequate job of measuring and managing health benefits.•64 % of 15 health benefits performance dimensions were managed by no one.•39 % of companies never requested any employee feedback about health benefits.•Lack of accountability is inconsistent with employer responsibilities for benefits.•This affects employees access to care and satisfaction with plan administrators. |
| ArticleNumber | 118131 |
| Author | Singer, Sara J. Pfeffer, Jeffrey Nikolov, Margaret C. |
| Author_xml | – sequence: 1 givenname: Sara J. orcidid: 0000-0002-3374-1177 surname: Singer fullname: Singer, Sara J. email: ssinger@stanford.edu organization: Department of Health Policy, Stanford University School of Medicine, Encina Commons, 615 Crothers Way, Stanford, CA, 94305, USA – sequence: 2 givenname: Jeffrey orcidid: 0000-0002-6278-9735 surname: Pfeffer fullname: Pfeffer, Jeffrey email: pfeff@stanford.edu organization: Stanford University Graduate School of Business, 655 Knight Way, Stanford, CA, 94305, USA – sequence: 3 givenname: Margaret C. surname: Nikolov fullname: Nikolov, Margaret C. email: nikolov@stanford.edu organization: Clinical Excellence Research Center, Center for Academic Medicine, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA |
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| Keywords | Measurement Health benefits administration Survey Management Accountability Employer-based health insurance |
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| SubjectTerms | Accountability Adult Employer-based health insurance Female Health Benefit Plans, Employee - organization & administration Health Benefit Plans, Employee - standards Health Benefit Plans, Employee - statistics & numerical data Health benefits administration Humans Male Management Measurement Social Responsibility Survey Surveys and Questionnaires United States |
| Title | An absence of accountability: Evidence of employers’ failure to measure and manage employee health benefits administration |
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