The cost of employee healthcare benefits around the globe is trending higher, driven largely by the higher cost of hospital and inpatient services, medical technology, and the overuse of services, according to a survey of medical insurers by Willis Towers Watson, a global advisory, brokering, and solutions company.

The Willis Towers Watson Global Medical Trends Survey was conducted between October and November 2015 and reflects responses from 174 leading medical insurers operating in 55 countries. Most participants have at least a 10% share of the group medical insurance market in their country.

The survey found that medical insurers are projecting the cost of healthcare benefits to increase 9.1% this year, an increase from 8.0% in 2015 and 7.5% in 2014. Insurers in the Americas (not including the U.S.) and Middle East/Africa regions are projecting double-digit average increases for the third straight year. The European region continues to show the lowest level of increase. Other Willis Towers Watson research shows U.S. employers are experiencing health benefit cost increases that are averaging several percentage points lower than those in other countries.

More than half of insurers in all regions anticipate higher, or significantly higher, medical trends over the next 3 years. Middle East and Africa insurers are particularly pessimistic, with 85% expecting the trend in the next 3 years to be higher or significantly higher.

“Rising medical costs continue to be a major issue for employers,” says Cecil Hemingway, cohead of Health and Benefits at Willis Towers Watson, quoted in a press release. “In the decade of running this survey, we have seen global medical trend continue to hover at double digit levels in many countries. However, the results by country can vary greatly. Some countries are seeing the rate of increases slowing while others are experiencing medium-term increases driven by demographics and economics, which could give way to a longer-term slowing of cost increases.”

According to the survey, hospital and inpatient services are the highest expenses driving the increases, although all other services are not far behind. When asked for the most significant cost-driving factors outside the control of employers and vendors, more than half of respondents (58%) cited the high cost of medical technology, followed by providers’ profit motives (44%).

Interestingly, three in four insurers (75%) ranked overuse of care due to medical practitioners recommending too many services as the most significant factor driving costs when it comes to employee and provider behavior.