With health care costs increasing and a major portion of employee benefits attributableto health care, employers have turned their attention to a range of strategies for controllingcosts. A typology of the employer role in employee health care is presentedwhich suggests that cost containment strategies may bring increasing influence by theemployer in the health care decisions of employees. Four roles for employers havebeen identified: (1) the Enabler, providing traditional health benefits, with increasinguse of deductibles and copayments; (2) the Advocate, providing benefit and alternativedelivery options (e.g., HMOs) with incentives for less costly choices; (3) the Mediator,providing programs which intervene in health care utilization decisions (e.g., secondsurgical opinions); and (4) the Provider, providing direct services at the workplace(e.g., screening and health promotion programs). Implications for employers, employees,and the health care system are raised.

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