美国医疗保险第三方管理市场分析及预测(按规模、份额、增长、趋势)2031 年

  • Report Code : TIPRE00039852
  • Category : Banking, Financial Services, and Insurance
  • Status : Published
  • No. of Pages : 73
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2024 年美国医疗保险第三方管理员市场规模价值 649.2 亿美元,预计到 2031 年将达到 1448.6 亿美元。预计 2024 年至 2031 年期间市场复合年增长率为 12.1%。采用人工智能驱动的工具和自动化可能会成为市场的一个主要趋势。

美国医疗保险第三方管理市场分析

美国医疗保险第三方管理人 (TPA) 市场的增长受到几个关键因素的推动,包括医疗成本的上涨、寻求节约成本的雇主越来越多地采用自筹资金的保险计划、医疗管理和法规遵从性的日益复杂以及对索赔处理、分析和会员支持等专业管理服务的需求不断增长。此外,远程医疗服务和雇主赞助的健康计划的扩展、对提高索赔裁决效率的需求以及第三方管理人为各种医疗保健需求提供定制解决方案的能力进一步推动了市场的发展。第三方管理人向人工智能驱动的工具和自动化的转变也导致对第三方管理人的依赖日益增加,以简化运营并降低保险公司和雇主的总体成本。

美国医疗保险第三方管理市场概览

第三方管理者 (TPA) 是管理保险计划的行政和运营职能的实体。这些职责通常包括处理索赔、招募参与者、收取保费以及确保遵守联邦法规。虽然 TPA 不制定保险计划的政策,但它们在确保有效实施政策方面发挥着至关重要的作用。TPA 可以与多家保险公司合作,为不同的计划和组织提供服务。虽然 TPA 通常与健康保险相关,但它还用于其他各种保险领域。例如,商业责任保险公司和退休计划管理者经常聘请 TPA 担任理赔员或提供客户支持服务。TPA 的范围从大型跨国公司到持有 TPA 认证的个人承包商。保险公司和拥有自筹资金健康计划的雇主经常将其索赔管理外包给 TPA,这一过程称为外包。

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美国医疗保险第三方管理市场驱动因素和机遇

医疗成本上涨

医疗服务、药物和保险费成本的不断增加,迫使保险公司和雇主寻求更高效、更具成本效益的方式来管理医疗保健计划。第三方管理员可以帮助简化索赔处理和管理功能,从而降低保险公司和雇主的运营成本。根据彼得·彼得森基金会的数据,美国的医疗保健支出很高,2022 年支出 4.5 万亿美元,相当于人均 13,493 美元。这明显高于其他发达国家的医疗保健支出,这些国家的人均成本还不到美国的一半。这种巨大的支出负担给保险公司、雇主和消费者带来了压力,推动了对更高效、更具成本效益的方式来管理医疗保健系统的需求。第三方管理员通过承担索赔处理、资格验证和福利管理等任务负担,帮助企业管理雇主赞助的健康保险计划。通过将这些责任外包给第三方管理员,公司可以专注于其核心业务,同时仍为员工提供有竞争力的医疗保健福利。

雇主赞助的健康计划日益增多

雇主赞助的健康保险 (ESI) 在美国发挥着重要作用,是非老年居民的主要健康保险来源,凸显了雇主和保险提供商对国家医疗保健系统的关键影响。根据 KFF 的数据,2023 年,约 60.4% 的 65 岁以下人士(即 1.647 亿人)通过 ESI 获得保障。与许多其他以国家医疗保健系统为主导的国家不同,美国严重依赖自愿的私人医疗保险,因此雇主提供的计划对于为工薪家庭提供医疗保险至关重要。

美国医疗保险第三方管理员市场报告细分分析

有助于得出美国医疗保险第三方管理员市场分析的关键部分是类型和企业规模。

  • 就类型而言,市场分为健康保险、残疾保险、工伤赔偿保险和其他保险。
  • 按照企业规模来看,市场分为大型企业和中小型企业。

美国医疗保险第三方管理者市场份额分析

美国医疗保险第三方管理人市场是一个充满活力的行业,其中包括各种公司和协会,他们致力于简化医疗保健管理并降低保险公司、雇主和计划参与者的成本。第三方管理人对于管理索赔处理、登记、客户支持和法规遵从等任务至关重要,使医疗保险公司和自保雇主能够专注于核心业务职能。Sedgwick、Crawford & Company、Meritain Health、UMR Inc. 和 Gallagher Bassett Services Inc 等几家知名公司在美国医疗保险第三方管理人市场中发挥着重要作用。这些公司不仅管理索赔,还提供医疗保健网络访问和供应商采购等额外服务,从而提高了健康计划管理的整体效率。同样,专业福利管理人协会(SPBA)、美国自保协会(SIIA)和全国第三方管理人协会(NATPA)等协会通过倡导支持自保行业的政策、为第三方管理人提供教育和认证、推广最佳实践,在塑造美国医疗保险第三方管理人市场格局方面发挥着关键作用。

 

美国医疗保险第三方管理员市场区域洞察

Insight Partners 的分析师已详细解释了预测期内影响美国医疗保险第三方管理市场的区域趋势和因素。本节还讨论了美国医疗保险第三方管理市场在北美、欧洲、亚太地区、中东和非洲以及南美洲和中美洲的细分市场和地理位置。

US Healthcare Insurance Third-Party Administrator Market
  • 获取美国医疗保险第三方管理市场的区域特定数据

美国医疗保险第三方管理员市场报告范围

报告属性细节
2024 年的市场规模649.2亿美元
2031 年市场规模1448.6亿美元
全球复合年增长率(2024 - 2031)12.1%
史料2021-2023
预测期2024-2031
涵盖的领域按类型
  • 健康保险
  • 残疾保险
  • 工伤赔偿保险
按企业规模
  • 大型企业
  • 中小企业
覆盖地区和国家我们
  • 我们
市场领导者和主要公司简介
  • 塞奇威克
  • 克劳福德公司
  • CorVel 公司
  • 联合健康集团
  • 亚瑟·J·加拉格尔公司
  • 美利坦健康
  • 爱迪生健康解决方案
  • 东芝电子集成系统
  • 坎农科克伦管理服务有限公司
  • 传统健康解决方案

 

美国医疗保险第三方管理市场参与者密度:了解其对业务动态的影响

美国医疗保险第三方管理市场正在快速增长,这得益于最终用户需求的不断增长,而这些需求又源于消费者偏好的不断变化、技术进步以及对产品优势的认识不断提高等因素。随着需求的增长,企业正在扩大其产品范围,进行创新以满足消费者的需求,并利用新兴趋势,从而进一步推动市场增长。

市场参与者密度是指在特定市场或行业内运营的企业或公司的分布情况。它表明在给定市场空间中,相对于其规模或总市场价值,有多少竞争对手(市场参与者)存在。

在美国医疗保险第三方管理市场运营的主要公司有:

  1. 塞奇威克
  2. 克劳福德公司
  3. CorVel 公司
  4. 联合健康集团
  5. 亚瑟·J·加拉格尔公司
  6. 美利坦健康

免责声明上面列出的公司没有按照任何特定顺序排列。


US Healthcare Insurance Third-Party Administrator Market

 

  • 了解美国医疗保险第三方管理员市场顶级关键参与者概况

美国医疗保险第三方管理人市场新闻及最新发展

美国医疗保险第三方管理者市场通过收集主要和次要研究后的定性和定量数据进行评估,其中包括重要的公司出版物、协会数据和数据库。美国医疗保险第三方管理者市场的一些发展情况如下:

  • Sedgwick 宣布了来自 Altas Partners 的战略投资。现有投资者,包括全球投资公司 Carlyle (NASDAQ: CG) 和 Stone Point Capital LLC 管理的基金,将继续作为投资者并继续对该业务进行重大新投资。Carlyle 将与投资者集团和 Sedgwick 管理团队合作,保持其控制地位。(来源:Sedgwick,新闻稿,2024 年 9 月)
  • Sedgwick 宣布了其人工智能 (AI) 技术计划的几项新更新。该技术的目标是通过预测、解决和自动化索赔生命周期中的步骤来加快索赔流程,从而增强消费者体验并简化索赔解决方案。(来源:Sedgwick,新闻稿,2024 年 5 月)

美国医疗保险第三方管理员市场报告覆盖范围和交付成果

“美国医疗保险第三方管理员市场规模和预测(2021-2031 年)”报告对市场进行了详细分析,涵盖以下领域:

  • 美国医疗保险第三方管理员市场规模以及范围内涵盖的所有关键细分市场的国家/地区预测
  • 美国医疗保险第三方管理员市场趋势,以及驱动因素、限制因素和关键机会等市场动态
  • 详细的 PEST 和 SWOT 分析
  • 美国医疗保险第三方管理员市场分析,涵盖关键市场趋势、国家框架、主要参与者、法规和最新市场发展
  • 行业格局和竞争分析,涵盖市场集中度、热图分析、知名参与者以及美国医疗保险第三方管理员市场的最新发展
  • 详细的公司简介
  • 历史分析(2 年)、基准年、预测(7 年)及复合年增长率
  • PEST 和 SWOT 分析
  • 市场规模价值/数量 - 全球、区域、国家
  • 行业和竞争格局
  • Excel 数据集
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Report Coverage
Report Coverage

Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends

Segment Covered
Segment Covered

This text is related
to segments covered.

Regional Scope
Regional Scope

North America, Europe, Asia Pacific, Middle East & Africa, South & Central America

Country Scope
Country Scope

This text is related
to country scope.

常见问题


What are the driving factors impacting the US Healthcare Insurance Third-Party Administrator market?

The rising healthcare costs and growing employer-sponsored health plans fuel the US Healthcare Insurance Third-Party Administrator market growth.

What are the future trends of the US Healthcare Insurance Third-Party Administrator market?

The adoption of AI-driven tools and automation is likely to be a key trend in the market.

Which are the leading players operating in the US Healthcare Insurance Third-Party Administrator market?

UMR Inc, Sedgwick, Corvel, ESIS, and Gallagher are among the leading players in the US Healthcare Insurance Third-Party Administrator market.

What would be the estimated value of the US Healthcare Insurance Third-Party Administrator market by 2031?

The estimated value of the US Healthcare Insurance Third-Party Administrator market is expected to reach US$ 144.86 billion by 2031.

What is the expected CAGR of the US Healthcare Insurance Third-Party Administrator market?

The market is expected to register a CAGR of 12.1% over the forecast period.

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The List of Companies - US Healthcare Insurance Third-Party Administrator Market

  1. Sedgwick
  2. Crawford and Company
  3. CorVel Corp
  4. UnitedHealth Group Inc
  5. Arthur J Gallagher & Co
  6. Heritage Health Solutions, Inc
  7. Edison Health Solutions
  8. Meritain Health
  9. Chubb Ltd
  10. Cannon Cochran Management Services Inc.
us-healthcare-insurance-third-party-administrator-market-cagr

The Insight Partners performs research in 4 major stages: Data Collection & Secondary Research, Primary Research, Data Analysis and Data Triangulation & Final Review.

  1. Data Collection and Secondary Research:

As a market research and consulting firm operating from a decade, we have published and advised several client across the globe. First step for any study will start with an assessment of currently available data and insights from existing reports. Further, historical and current market information is collected from Investor Presentations, Annual Reports, SEC Filings, etc., and other information related to company’s performance and market positioning are gathered from Paid Databases (Factiva, Hoovers, and Reuters) and various other publications available in public domain.

Several associations trade associates, technical forums, institutes, societies and organization are accessed to gain technical as well as market related insights through their publications such as research papers, blogs and press releases related to the studies are referred to get cues about the market. Further, white papers, journals, magazines, and other news articles published in last 3 years are scrutinized and analyzed to understand the current market trends.

  1. Primary Research:

The primarily interview analysis comprise of data obtained from industry participants interview and answers to survey questions gathered by in-house primary team.

For primary research, interviews are conducted with industry experts/CEOs/Marketing Managers/VPs/Subject Matter Experts from both demand and supply side to get a 360-degree view of the market. The primary team conducts several interviews based on the complexity of the markets to understand the various market trends and dynamics which makes research more credible and precise.

A typical research interview fulfils the following functions:

  • Provides first-hand information on the market size, market trends, growth trends, competitive landscape, and outlook
  • Validates and strengthens in-house secondary research findings
  • Develops the analysis team’s expertise and market understanding

Primary research involves email interactions and telephone interviews for each market, category, segment, and sub-segment across geographies. The participants who typically take part in such a process include, but are not limited to:

  • Industry participants: VPs, business development managers, market intelligence managers and national sales managers
  • Outside experts: Valuation experts, research analysts and key opinion leaders specializing in the electronics and semiconductor industry.

Below is the breakup of our primary respondents by company, designation, and region:

Research Methodology

Once we receive the confirmation from primary research sources or primary respondents, we finalize the base year market estimation and forecast the data as per the macroeconomic and microeconomic factors assessed during data collection.

  1. Data Analysis:

Once data is validated through both secondary as well as primary respondents, we finalize the market estimations by hypothesis formulation and factor analysis at regional and country level.

  • Macro-Economic Factor Analysis:

We analyse macroeconomic indicators such the gross domestic product (GDP), increase in the demand for goods and services across industries, technological advancement, regional economic growth, governmental policies, the influence of COVID-19, PEST analysis, and other aspects. This analysis aids in setting benchmarks for various nations/regions and approximating market splits. Additionally, the general trend of the aforementioned components aid in determining the market's development possibilities.

  • Country Level Data:

Various factors that are especially aligned to the country are taken into account to determine the market size for a certain area and country, including the presence of vendors, such as headquarters and offices, the country's GDP, demand patterns, and industry growth. To comprehend the market dynamics for the nation, a number of growth variables, inhibitors, application areas, and current market trends are researched. The aforementioned elements aid in determining the country's overall market's growth potential.

  • Company Profile:

The “Table of Contents” is formulated by listing and analyzing more than 25 - 30 companies operating in the market ecosystem across geographies. However, we profile only 10 companies as a standard practice in our syndicate reports. These 10 companies comprise leading, emerging, and regional players. Nonetheless, our analysis is not restricted to the 10 listed companies, we also analyze other companies present in the market to develop a holistic view and understand the prevailing trends. The “Company Profiles” section in the report covers key facts, business description, products & services, financial information, SWOT analysis, and key developments. The financial information presented is extracted from the annual reports and official documents of the publicly listed companies. Upon collecting the information for the sections of respective companies, we verify them via various primary sources and then compile the data in respective company profiles. The company level information helps us in deriving the base number as well as in forecasting the market size.

  • Developing Base Number:

Aggregation of sales statistics (2020-2022) and macro-economic factor, and other secondary and primary research insights are utilized to arrive at base number and related market shares for 2022. The data gaps are identified in this step and relevant market data is analyzed, collected from paid primary interviews or databases. On finalizing the base year market size, forecasts are developed on the basis of macro-economic, industry and market growth factors and company level analysis.

  1. Data Triangulation and Final Review:

The market findings and base year market size calculations are validated from supply as well as demand side. Demand side validations are based on macro-economic factor analysis and benchmarks for respective regions and countries. In case of supply side validations, revenues of major companies are estimated (in case not available) based on industry benchmark, approximate number of employees, product portfolio, and primary interviews revenues are gathered. Further revenue from target product/service segment is assessed to avoid overshooting of market statistics. In case of heavy deviations between supply and demand side values, all thes steps are repeated to achieve synchronization.

We follow an iterative model, wherein we share our research findings with Subject Matter Experts (SME’s) and Key Opinion Leaders (KOLs) until consensus view of the market is not formulated – this model negates any drastic deviation in the opinions of experts. Only validated and universally acceptable research findings are quoted in our reports.

We have important check points that we use to validate our research findings – which we call – data triangulation, where we validate the information, we generate from secondary sources with primary interviews and then we re-validate with our internal data bases and Subject matter experts. This comprehensive model enables us to deliver high quality, reliable data in shortest possible time.