Although they differ significantly in terms of volatility of medical costs from one year to the next, the workforce of small and large employers share more similarities than differences.  Based on a health risk survey of over 6,000 consumers with group health insurance conducted by DSS Research, employees of small, medium and large companies have similar levels of health care usage, physical functioning, mental health and average medical claims.
If anything, employees working at the smallest companies (2 to 50 employees)  have  fewer chronic conditions, are less likely to have ever smoked and have slightly better health overall.  These minor differences are likely a result of more stringent underwriting in the small group market for states where community rating is not mandated.
Larger companies (1,000+ employees) are somewhat more likely to participate in preventive care activities, are slightly better at managing stress and they take slightly fewer risks in their daily lives.  A greater level of access to health and wellness programs, as well as, psychological counseling and other EAP services likely explains the small advantage larger companies have in these areas.
The DSS Health Care Engagement Index (HCEI)™ shows no significant differences between large and small employers regarding their employees’ overall level of health care engagement.  Health literacy and health-related knowledge are also comparable across small and large employers.
Certainly, any specific small group may have wildly different health risk and engagement characteristics from the typical large group, but as a whole, the small group market is not any riskier than large employer groups.