References
Sources & References
Every statistic we cite across the site links here. These are the studies, surveys, and industry datasets behind the numbers — so you can verify them yourself.
- 1.
Mercer 2025 National Survey of Employer-Sponsored Health Plans: projected 6.5% cost increase for 2026 (highest in 15 years); per-employee cost expected to exceed $18,500; the increase would near 9% absent plan changes.
- 2.
AHRQ Medical Expenditure Panel Survey (MEPS): the top 5% of the population accounts for ~50% of total health spending and the top 10% for ~66–70% — the concentration behind the 5–10% / 50–70% figure. Marathon Health summarizes the same pattern for employers.
- 3.
UnitedHealth Group (July 2019), “The High Cost of Avoidable Hospital Emergency Department Visits”: primary-care-treatable (avoidable) ED visits cost about $2,032 on average — roughly 10–12× the cost of an urgent-care ($193) or office ($167) visit.
- 4.
National Safety Council, Injury Facts (underlying data from the National Council on Compensation Insurance): the average workers' compensation claim was $47,316 for accidents in 2022–2023.
- 5.
Milliman / Society of Actuaries, “Direct Primary Care: Evaluating a New Model of Delivery and Financing” (May 2020): DPC members showed ~40% fewer ER visits and ~12.6% lower risk-adjusted total claims costs over a two-year period.
- 6.
International Foundation of Employee Benefit Plans (IFEBP), 2026 cost survey: U.S. employers project a median health-care cost increase of 10% for 2026.
- 7.
Premise Health, 2024 Book of Business Analysis (methodology validated by Milliman; ~207,000 eligible lives across 26 employers): advanced primary care saved attributed members an average of $2,434, or ~30%, on total cost of care.
- 8.
Origins of employer-sponsored health insurance — the 1942 wartime wage freeze, the 1943 War Labor Board ruling exempting fringe benefits, and the 1954 Internal Revenue Code codifying the tax exclusion. Economic-history research by Melissa Thomasson is the scholarly root; popular histories cover the same arc.
- 9.
ACA Employer Shared Responsibility Provision (IRC §4980H): applicable large employers (50+ full-time-equivalent employees) must offer minimum-value, affordable coverage to at least 95% of full-time employees or face IRS penalties — phased in for 2015 (large employers) and 2016 (50–99 employees).
- 10.
KFF 2025 Employer Health Benefits Survey: employer-sponsored insurance covers ~154 million people under age 65; average annual premiums reached $9,325 (single) and $26,993 (family) in 2025, rising 5% and 6% respectively — outpacing wage growth and inflation.
- 11.
CMS Office of the Actuary, National Health Expenditures 2023 (published in Health Affairs): private health insurance spending reached about $1.5 trillion in 2023, the large majority of it employer-sponsored.
- 12.
Harvard Kennedy School: for most companies, healthcare is the second-largest line in the operating budget after wages.
- 13.
Centers for Medicare & Medicaid Services. National Health Expenditure Accounts, 2024 (NHE Fact Sheet; “The Nation’s Health Dollar — Where It Went”). The U.S. spent roughly $5.3 trillion on health care in 2024 — about 18% of GDP, or ~$15,500 per person. Of every dollar, hospital care is ~31 cents, physician and clinical services ~21 cents, retail prescription drugs ~9 cents, and “government administration and the net cost of health insurance” just ~7 cents.
- 14.
American Medical Association. Medicare physician pay has plummeted since 2001 (33% decline, inflation-adjusted), 2025. Adjusted for inflation in practice costs, Medicare’s payment to physicians has fallen 33% since 2001, even as the cost of running a practice rose 59% over the same period.
- 15.
Himmelstein DU, Campbell T, Woolhandler S. Health Care Administrative Costs in the United States and Canada, 2017. Ann Intern Med. 2020;172:134–142. Insurers and providers together spent $812 billion on administration in 2017 — 34.2% of national health expenditures. A subsequent JAMA analysis (Sahni, Carrus & Cutler, 2021) independently estimated that administrative simplification could save roughly $265 billion a year, reinforcing the scale of this spending.
- 16.
Himmelstein DU, Jun M, Busse R, et al. A Comparison of Hospital Administrative Costs in Eight Nations. Health Aff. 2014;33(9):1586–1594 (Commonwealth Fund summary). U.S. hospital administration runs roughly 25% of hospital spending — the highest of the nations studied.
- 17.
Tseng P, Kaplan RS, Richman BD, et al. Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. JAMA. 2018;319(7):691–697. Billing and insurance-related work consumes roughly 8% to 25% of professional revenue depending on the type of visit. A Health Affairs analysis of 44.5 million claims (Gottlieb, Shapiro & Dunn, 2018) found this billing friction generates an estimated $11–54 billion in challenged revenue each year.
- 18.
Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. Waste is estimated at $760–935 billion a year (~25% of spending), with administrative complexity the single largest domain at ~$265.6 billion — and no intervention proven to reduce it. This built on the foundational six-category waste framework of Berwick & Hackbarth (JAMA, 2012), which first estimated total waste — administrative complexity among its largest domains — at more than 20% of US health spending.
- 19.
American Medical Association. 2024 Prior Authorization Physician Survey. Physicians complete an average of 39 prior-authorization requests per week, consuming roughly 13 hours of physician and staff time, and 40% of practices employ staff who work exclusively on prior authorizations. A peer-reviewed survey in Health Affairs Scholar (Sahni, Istvan, Stafford & Cutler, 2024) corroborated the burden, with 92% of providers reporting prior-authorization-related delays in care.
- 20.
Federal Trade Commission. Pharmacy Benefit Managers (Interim Staff Report, 2024; Express Scripts settlement, 2026). The three largest PBMs — CVS Caremark, Express Scripts, and OptumRx — process about 79% of U.S. prescription drug claims, and the six largest control roughly 94%. The FTC’s investigation into opaque rebate practices led to a structural settlement with Express Scripts in February 2026. A peer-reviewed JAMA analysis of 90% of US retail prescriptions (Qato, Chen & Van Nuys, 2024) independently confirmed this market concentration.
- 21.
Kaiser Family Foundation. What to Know About Pharmacy Benefit Managers (PBMs), 2025. An overview of how PBMs operate and federal efforts to regulate them, corroborating the concentration of the prescription-drug market among a handful of the largest PBMs.
- 22.
Integrated Benefits Institute, “Poor Health Costs US Employers $575 Billion and 1.5 Billion Days of Lost Productivity” (analysis drawing on data from ~66,000 U.S. employers). Poor employee health costs U.S. employers $575 billion annually and nearly 1.5 billion days of lost productivity; for every dollar spent on healthcare benefits, another $0.61 is lost to illness- and injury-related productivity loss — roughly $3,900 per employee per year.
- 23.
National Safety Council, Injury Facts (underlying data from the National Council on Compensation Insurance): the average lost-time workers' compensation claim was $47,316 for accidents in 2022–2023. The most costly claims by part of body involve the head or central nervous system, averaging $90,043, and the most costly by nature of injury are amputations, averaging $125,058.
- 24.
Workers' Compensation Research Institute (WCRI), “Workers' Comp Provider Networks Cut Total Claim Costs by 26%” (2026; more than seven-days-lost-time claims across 34 states, experience through March 2024). In-network/coordinated medical management claims cost 26% — about $11,820 — less per claim at 36 months of maturity than out-of-network claims, and shorten temporary-disability duration (15.8 vs. 17.4 weeks).
- 25.
OSHA Recordkeeping Standard, 29 CFR Part 1904 — Recording and Reporting Occupational Injuries and Illnesses. Whether and how a work-related injury is recorded on the OSHA 300 log is a technical determination with specific clinical criteria; recordability affects a company's TRIR, DART rate, and experience modification rate, which influence workers' compensation premiums.
- 26.
OSHA substance-specific health standards — including respirable crystalline silica (29 CFR 1910.1053), lead (1910.1025), asbestos (1910.1001), and occupational noise — require medical surveillance performed by or under the supervision of a licensed physician or other licensed healthcare professional.
- 27.
ACA Medical Loss Ratio (the 80/20 rule), HealthCare.gov: insurers must spend at least 80% of premium dollars on medical care and quality improvement in the individual and small-group market, and at least 85% in the large-group market; the remainder funds administration, overhead, and profit, and shortfalls are rebated to policyholders.
- 28.
PolitiFact, “Comparing administrative costs for private insurance and Medicare” (2017): private insurers spend roughly 12–18% of premiums on administration. Consistent with the ACA Medical Loss Ratio caps, between 15% and 20% of every premium dollar goes to administrative costs, overhead, and profit before a claim is paid; the Congressional Budget Office has estimated administrative loads of ~20% (nongroup), ~16% (small group), and ~11% (large group) by market segment.
- 29.
Eskew PM, Klink K. “Direct Primary Care: Practice Distribution and Cost Across the Nation.” J Am Board Fam Med. 2015;28(6):793–801, and the 2015 DPC practice survey: DPC eliminates third-party fee-for-service billing and charges a flat periodic membership fee; 92% of practices offer same-day appointments and 74% offer wholesale labs. DPC practice data show wholesale lab pricing 60–90% below insurance-billed rates — e.g., a basic metabolic panel that bills at $200+ through insurance networks runs roughly $10–25 at wholesale pricing.
- 30.
U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses, CY2024 (USDL-26-0101): cases with days away from work, job restriction, or transfer that involve days away represent roughly 38% of total recordable cases in private industry. This is the lost-time share (0.38) the True Cost of Health model uses to convert expected recordables into lost-time workers' compensation claims before applying the average lost-time claim cost (source 23).
Figures are drawn from the most recent public data available at the time of writing and are provided for general illustration. Actual results vary by workforce, industry, and program scope. Where we show cost savings or ranges, they reflect published industry studies, not a guarantee of results for any specific employer.