Self-Insured Firms Struggle to Drive Hard Bargains With Health Care Providers

Self-insured plans pay higher prices for many health care services compared with fully insured plans, according to an analysis of claims data published in this month’s issue of Health Affairs. Aditi P. Sen, Ph.D., the study’s lead author, says the findings “suggest that employers are generally not able to negotiate prices on behalf of their employees, and I don’t think that should be surprising. It really reflects the dynamics in health care markets.”

In self-insured plans, employers assume financial responsibility for their workers’ health care claims rather than having a health insurer take on that risk — theoretically giving such companies more incentive to drive costs down.

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Tim Casey

Tim Casey

Tim has been a reporter and editor for newspapers, websites and magazines for more than 20 years, including 10 years covering health care business topics. He has a deep knowledge of the managed care industry and pharmacy benefit management. He also has experience covering medical conferences and clinical and legislative health care issues. In 2014, the Society for Advancing Business Editing and Writing selected Tim as one of 15 journalists to participate in a national symposium on the Affordable Care Act. Tim has a B.A. in Psychology from the University of Notre Dame and an M.B.A. from Georgetown University.

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