1. What is the existing health care infrastructure in each location, and how can you enhance it to drive employees to high-value health care services?

While each nation’s infrastructure is unique, public health care systems are under strain in many regions. For instance, in Europe, 75% of insurers cite the decline in public health systems as the primary reason for cost increases, as employees increasingly turn to private health care providers.

Moreover, varying regulatory or legal considerations may impact certain health care initiatives. Employers may need to partner with influential labor unions or work councils in some nations. Other countries may have stricter limitations regarding private employers’ ability to influence employees’ health decisions.

For consideration:

• Where do public health care systems perform effectively? Where are you filling gaps?
• Are regulatory frameworks, such as labor unions and privacy laws, limiting flexibility?
• Where do you need customization and where can you standardize expectations?

2. Where do costs originate, and which cost drivers are controllable?

When you make a global benefits decision, it is essential to be clear on which specific cost driver you are trying to address and whether the change will meaningfully move that needle. Understanding the full landscape will help to inform employers’ decision-making.

For consideration:

• Do you know the top three drivers of your health care cost in each major market?
• Are you addressing prevention for top cost drivers such as cancer, cardiovascular disease and metabolic conditions, or just managing claims after the fact?
• Where is the real “cost vs. employee experience” trade-off, keeping in mind that aggressive cost controls can backfire, for instance, if they are accompanied by delays in care.

3. Do you have a vendor ecosystem or disconnected point solutions?

More than half of global insurers report that costs surge when health care services are not integrated across facilities and then overused. This is in part due to a lack of coordination while using a mix of country-specific, regional and global providers. In addition, holding point solutions mutually accountable for integrating communications and data where it is possible and legal can drive efficiency and improve employee experience.

For consideration:

• Are your point solutions integrating data and coordinating referrals, or are members getting duplicate services?
• Who owns the end-to-end member experience in each market?
• Is your organization holding all partners, including insurers, administrators and other vendors, mutually accountable for outcomes? Or are they operating in silos?

4. Are you ready for the fastest growing clinical cost areas?

Mental health: 30% of multinational employers report that mental health conditions are driving health care costs on a global level, and 43% report offering mental health services to manage health care costs and/or improve employee health in most or all countries in which they operate. [Business Group on Health 2026 Employer Health Care Strategy Survey]

Cancer: 74% of all employers are currently seeing the impact of a higher prevalence of cancers in their population over previous years, with many also focusing on screenings and methods of early detection to help combat rates of cancer amongst employees. [Business Group on Health 2026 Employer Health Care Strategy Survey]

Cardiovascular/metabolic: Still a leading cost driver globally, exacerbated by expensive drug innovation (e.g., GLP-1s for obesity/diabetes).

For consideration:

• Does your organization have measurable programs targeting the areas of mental health, cancer and cardiovascular/metabolic?
• Are they appropriate for each market's culture and regulations?

5. What is your measurement strategy when global metrics are inconsistent?

Across markets, inclusive benefits design is uneven because culture and regulations vary, and data privacy laws differ. Some countries do not allow for the collection of sensitive demographic information, for instance; while patient outcomes data registries have emerged, transparency remains limited.

For consideration:

• Is there a defined minimum global dataset, using categories such as medical trend, top conditions, high-cost claims prevalence, utilization signals or disability/absence intersection?
• Are you comfortable starting with imperfect data and iterating?
• Are you encouraging partners to provide better data where legally permissible and collaborating with external organizations such as the International Consortium for Health Outcomes Measurement to improve standardization?
• Have you considered the use of a multi-national pool or captive approach that would enable more control over your organization’s data, and therefore your metrics?