Study identifies cancer, cardiovascular disease as major drivers of employers’ health care costs

In a recent survey, researchers identified rising costs, socioeconomic inequality and drug trends as top concerns for large employers.

More employers report cancer as the top driver of health care costs at large companies, according to 2023 Large Employer Health Care Strategy and Plan Design Survey, administered from the Health Business Group.

Cancer, cardiovascular disease, and musculoskeletal conditions have peaked as the top 3 health care costs for 2 consecutive years in the survey. However, employers reported a 13% increase in late-stage cancers and approximately 45% anticipate a similar increase in the future due to delayed screenings caused by the COVID-19 pandemic.

“The survey findings serve as a ‘collective picture’ that can guide employers as they determine how to maximize employee benefits,” said Ellen Kelsay, president and CEO of Business Group on Health, in a press release.

Employers are concerned beyond their costs, according to the survey, including concerns about health equity and affordable health care. Employers claim to invest in health and wellness offerings for employees.

Between May 31, 2022 and July 13, 2022, researchers administered the survey to 135 large companies, which share a total of more than 18 million employees. The survey collected employer-sponsored health care data, including costs and health care plan design, for 2023.

Key areas of concern for employers included:

  • Rising costs. In 2021, actual health care costs increased by an average of 8.2%, after no increase in costs from 2019 to 2020.
  • Costly employee coverage. According to the survey, large employers expected to cover 82% of the cost of employee coverage this year, up from 80% last year. Employers are seeking long-term cost changes, such as targeting volatile health care spending and prescription drug costs.
  • Prescription drug trend. Among large employers, 99% admitted to some concern about it—in 2021, prescription drugs accounted for 21% of employer health care costs, with more than 50% of drugs including specialty medications.
  • Long-term mental health problems. Survey responses showed that 43% of large employers believe long-term mental health is the top health-related issue of the pandemic, with nearly the same percentage of large employers identifying it as a future health care issue. Consequently, 85% of large employers reported that they will maintain pandemic-related health and wellness services.
  • Policy to reduce health care and prescription drug costs-Especially for new gene therapies and affordable daily medications. Almost a quarter of employers have invested in virtual health at little or no cost.
  • Integrating virtual health. Among employers, nearly 84% said hybrid virtual and in-person healthcare is critical to success, and more than 30% will offer virtual primary care services in 2022.
  • Health and wellness strategy. The survey showed that 65% of employers say health and wellness is an integral part of the workforce. They noted that it was an important factor in retaining staff, supporting overall employee well-being and influencing business performance and culture.
  • Health equity. Nearly 75% of employers indicated they believe in health equity, planning to address racism, childcare, transportation and food access/insecurity by 2025. Roe v. Wade about protected abortion has continued to worry employers.

Kelsay and team found that employers could create “a more positive and sustainable health care experience, among other things,” because of these findings.


Health Business Group. Cancer Now Top Driver of Employer Health Care Costs, Says Business Group Health Care Strategy and Plan Survey 2023. News Release. August 23, 2022. Accessed August 23, 2022.

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