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1662890

2030 年醫療保健 EDI 市場預測：按交易類型、組件、部署、最終用戶和地區進行的全球分析

Healthcare EDI Market Forecasts to 2030 - Global Analysis By Transaction Type, Component, Deployment, End User and By Geography
出版日期: | 出版商: Stratistics Market Research Consulting | 英文 200+ Pages | 商品交期: 2-3個工作天內

價格

根據 Stratistics MRC 的數據，全球醫療保健 EDI 市場預計在 2024 年達到 45 億美元，到 2030 年將達到 81 億美元，預測期內的複合年成長率為 10.3%。

醫療保健 EDI（電子資料交換）是一種允許電腦系統交換和使用資訊的系統。具體來說，在醫療保健領域，它描述了醫院、保險公司和政府機構等各種醫療保健組織之間交換醫療保健資料的標準格式。醫療保健索賠交易、發票、病患資料、處方箋等可以按照定義的格式和程序安全地交換。

根據澳洲數位健康機構預測，2022年7月將有1.182億次遠距醫療服務惠及1,800萬人，目前約有9.5萬名醫護人員正在使用遠距醫療服務。

對效率和降低成本的需求日益增加

醫療保健 EDI 市場受提高業務效率和降低成本的需求所驅動。 EDI 可自動執行索賠處理、計費和保險驗證等管理業務，消除人工錯誤並節省時間。這種效率將減少人事費用和紙張成本等業務費用，同時也透過更快的資料處理改善現金流。由於醫療保健組織面臨成本上升和改善資源配置的需求，EDI 提供了一種可擴展的解決方案，可簡化工作流程並最佳化資源利用率，使其成為市場成長的主要驅動力。

互通性問題

互通性挑戰阻礙了 EDI 系統與現有醫療保健IT基礎設施的無縫整合。不同的資料標準、過時的舊有系統以及 HL7 和 FHIR 等通訊協定的不一致實現相關人員之間的資料交換變得複雜。這些問題增加了成本並減緩了採用速度，特別是對於資源有限的小型醫療保健提供者。克服這些障礙需要在標準化工作和客製化解決方案方面進行大量投資，儘管 EDI 具有潛在優勢，但這可能會減緩市場成長。

API 整合

API 和 EDI 系統的整合實現了即時資料交換和不同系統之間的無縫連接，從而帶來了巨大的成長機會。 API 透過自動化工作流程、減少錯誤和提高交易速度來增強索賠管理流程。這項創新支持了醫療保健領域日益成長的互通性需求，同時解決了傳統 EDI 系統的限制。隨著醫療保健機構擴大採用雲端基礎的平台等先進技術，API 整合有望提高效率並擴大市場應用。

資料外洩和網路攻擊

由於電子交換的患者資訊的敏感性，資料外洩對醫療保健 EDI 市場構成了重大威脅。針對EDI系統的網路攻擊可能導致未授權存取、財務損失和聲譽損害。實施強力的安全措施的高成本進一步加劇了這項挑戰。

COVID-19 的影響

COVID-19 疫情加速了遠距醫療和遠端監控等數位解決方案的採用，對醫療保健 EDI 市場產生了重大影響。社交距離措施增加了對電子資料交換的需求，以簡化索賠處理並減少行政負擔。然而，供應鏈中斷和資金限制導致一些地區的推廣速度減慢。儘管存在這些挑戰，但這場疫情凸顯了高效資料管理的重要性，並將 EDI 定位為未來以成本控制和技術進步為重點的醫療改革的重要工具。

預測期內，本地 EDI 市場規模預計將達到最大

由於本地 EDI 領域管理敏感醫療資料的能力強，預計在預測期內將佔據最大的市場佔有率。具有增強安全功能的內部部署解決方案是首選，尤其是在處理大量患者記錄和索賠資料時。這些系統受到大型醫院和保險公司的青睞，因為它們需要強大的基礎設施來滿足 HIPAA 等合規標準。雖然初始成本高於雲端基礎的替代方案，但其可靠性和客製化選項使其成為複雜的醫療保健業務必不可少的。

預計預測期內醫療保健提供者將以最高的複合年成長率成長。

預計醫療保健提供者在預測期內將經歷最高的成長率。這是因為他們依靠 EDI 來自動化索賠處理、裁決和付款工作流程。透過減少管理成本和錯誤，EDI 使付款人能夠有效地處理大量交易。對基於價值的護理模式的日益關注，使得尋求簡化業務同時改善患者治療效果的付款人對先進的資料交換解決方案的需求越來越大。

比最大的地區

在預測期內，北美預計將佔據最大的市場佔有率，這得益於其先進的醫療保健基礎設施、電子健康記錄(EHR) 的廣泛採用以及 HIPAA 等法規。該地區正看到 McKesson Corporation 和 Optum Inc. 等大型公司對技術進行大量投資，以提高系統之間的互通性。成熟的保險網路也鞏固了北美在該市場的主導地位。

複合年成長率最高的地區

由於中國和印度等國家的醫療保健系統快速數位化，預計亞太地區在預測期內將呈現最高的複合年成長率。政府推動醫療保健 IT 應用的舉措和對高效索賠管理解決方案的不斷成長的需求正在推動該地區市場的成長。醫療旅遊業的擴張和對電子資料交換優勢的認知不斷提高，進一步促進了亞太地區成為醫療保健 EDI 高成長地區的地位。

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    • 根據客戶興趣對主要國家進行市場估計、預測和複合年成長率（註：基於可行性檢查）
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    • 根據產品系列、地理分佈和策略聯盟對主要企業基準化分析

目錄

第1章執行摘要

第 2 章 前言

  • 概述
  • 相關利益者
  • 研究範圍
  • 調查方法
    • 資料探勘
    • 資料分析
    • 資料檢驗
    • 研究途徑
  • 研究資訊來源
    • 主要研究資訊來源
    • 二手研究資料資訊來源
    • 先決條件

第3章 市場走勢分析

  • 介紹
  • 驅動程式
  • 限制因素
  • 機會
  • 威脅
  • 最終用戶分析
  • 新興市場
  • COVID-19 的影響

第 4 章 波特五力分析

  • 供應商的議價能力
  • 買家的議價能力
  • 替代品的威脅
  • 新進入者的威脅
  • 競爭對手之間的競爭

5. 全球醫療保健 EDI 市場按交易類型分類

  • 介紹
  • 索賠管理
    • 提交索賠
    • 查詢理賠狀態
    • 保險付款
  • 資格驗證
  • 病患資訊管理
  • 藥房資料交換
  • 其他

6. 全球醫療保健 EDI 市場（按組件分類）

  • 介紹
  • 軟體解決方案
    • EDI 解決方案
    • 整合平台
    • 分析工具
  • 服務
    • 實施服務
    • 支援和維護
    • 培訓服務

第 7 章 全球醫療保健 EDI 市場（按部署）

  • 介紹
  • 本地 EDI
  • 雲端基礎的EDI

第 8 章 全球醫療保健 EDI 市場（按最終用戶）

  • 介紹
  • 醫療保健提供者
    • 醫院
    • 診所
    • 長期照護機構
  • 醫療保健付款人
    • 保險公司
    • 政府
  • 清算所
  • 其他

9. 全球醫療保健 EDI 市場（按地區）

  • 介紹
  • 北美洲
    • 美國
    • 加拿大
    • 墨西哥
  • 歐洲
    • 德國
    • 英國
    • 義大利
    • 法國
    • 西班牙
    • 其他歐洲國家
  • 亞太地區
    • 日本
    • 中國
    • 印度
    • 澳洲
    • 紐西蘭
    • 韓國
    • 其他亞太地區
  • 南美洲
    • 阿根廷
    • 巴西
    • 智利
    • 南美洲其他地區
  • 中東和非洲
    • 沙烏地阿拉伯
    • 阿拉伯聯合大公國
    • 卡達
    • 南非
    • 其他中東和非洲地區

第10章 主要進展

  • 協議、夥伴關係、合作和合資企業
  • 收購與合併
  • 新產品發布
  • 業務擴展
  • 其他關鍵策略

第11章 公司概況

  • McKesson Corporation
  • Cognizant
  • UnitedHealth Group
  • IBM
  • Experian Information Solutions
  • The SSI Group
  • Optum Inc.
  • GE Healthcare
  • Cerner Corporation
  • Allscripts Healthcare Solutions
  • Veradigm LLC
  • NTT DATA Group Corporation
  • Comarch SA
  • Axway
  • Availity LLC
  • Quadax Inc.
  • Waystar
  • Inovalon
Product Code: SMRC28752

According to Stratistics MRC, the Global Healthcare EDI Market is accounted for $4.5 billion in 2024 and is expected to reach $8.1 billion by 2030 growing at a CAGR of 10.3% during the forecast period. Healthcare EDI (Electronic Data Interchange) is a system that enables computer systems to exchange and use information. In healthcare specifically, it provides a standard format for exchanging health care data between various health organizations like hospitals, insurance companies, and government entities. It securely facilitates the exchange of medical claims processing, invoices, patient data, and prescriptions using defined formats and procedures.

According to the Australian Digital Health Agency, 118.2 million telehealth therapy services were provided to 18 million individuals in July 2022, with nearly 95,000 practitioners currently employing telehealth services.

Market Dynamics:

Driver:

Increasing need for efficiency and cost reduction

The healthcare EDI market is driven by the necessity to enhance operational efficiency and reduce costs. EDI automates administrative tasks like claims processing, billing, and insurance verification, eliminating manual errors and saving time. This efficiency reduces operational expenses, including labor and paper costs, while improving cash flow through faster data processing. As healthcare organizations face rising costs and demands for better resource allocation, EDI offers a scalable solution to streamline workflows and optimize resource utilization, making it a critical driver for market growth.

Restraint:

Interoperability issues

Interoperability challenges hinder the seamless integration of EDI systems with existing healthcare IT infrastructures. Variations in data standards, outdated legacy systems, and inconsistent implementation of protocols like HL7 or FHIR complicate data exchange between stakeholders. These issues increase costs and delay adoption, particularly for smaller healthcare providers with limited resources. Overcoming these barriers requires significant investment in standardization efforts and customized solutions, which can slow market growth despite EDI's potential benefits.

Opportunity:

API integration

The integration of APIs with EDI systems presents a significant growth opportunity by enabling real-time data exchange and seamless connectivity between disparate systems. APIs enhance claims management processes by automating workflows, reducing errors, and improving transaction speed. This innovation supports the growing demand for interoperability in healthcare while addressing the limitations of traditional EDI systems. As healthcare organizations increasingly adopt advanced technologies like cloud-based platforms, API integration is poised to drive efficiency and expand market applications.

Threat:

Data breaches and cyberattacks

Data breaches pose a critical threat to the healthcare EDI market due to the sensitive nature of patient information exchanged electronically. Cyberattacks targeting EDI systems can lead to unauthorized access, financial losses, and reputational damage. The high cost of implementing robust security measures further exacerbates this challenge.

Covid-19 Impact:

The Covid-19 pandemic significantly impacted the healthcare EDI market by accelerating the adoption of digital solutions like telehealth and remote monitoring. Social distancing measures increased the demand for electronic data exchange to streamline claims processing and reduce administrative burdens. However, disruptions in supply chains and financial constraints slowed implementation in some regions. Despite these challenges, the pandemic highlighted the importance of efficient data management, positioning EDI as a vital tool for future healthcare reforms focused on cost containment and technological advancement.

The on-premise EDI segment is expected to be the largest during the forecast period

The on-premise EDI segment is expected to account for the largest market share during the forecast period due to its ability to provide greater control over sensitive healthcare data. Organizations prefer on-premise solutions for their enhanced security features, particularly when handling large volumes of patient records and claims data. These systems are favored by large hospitals and insurers that require robust infrastructure to meet compliance standards like HIPAA. Despite higher initial costs compared to cloud-based alternatives, their reliability and customization options make them indispensable for complex healthcare operations.

The healthcare payers segment is expected to have the highest CAGR during the forecast period

Over the forecast period, the healthcare payers segment is predicted to witness the highest growth rate due to their reliance on EDI for automating claims processing, adjudication, and payment workflows. By reducing administrative costs and errors, EDI enables payers to handle high transaction volumes efficiently. The increasing focus on value-based care models further drives demand for advanced data exchange solutions among insurers aiming to streamline operations while improving patient outcomes.

Region with largest share:

During the forecast period, the North America region is expected to hold the largest market share due to its advanced healthcare infrastructure, widespread adoption of electronic health records (EHRs), and regulatory mandates like HIPAA. The region benefits from significant investments in technology by major players such as McKesson Corporation and Optum Inc., which enhance interoperability across systems. The presence of established insurance networks further supports the dominance of North America in this market.

Region with highest CAGR:

Over the forecast period, the Asia Pacific region is anticipated to exhibit the highest CAGR due to rapid digitalization in healthcare systems across countries like China and India. Government initiatives promoting health IT adoption, coupled with rising demand for efficient claims management solutions, drive market growth in this region. The expansion of medical tourism and increasing awareness about electronic data exchange advantages further bolster Asia Pacific's position as a high-growth region for healthcare EDI.

Key players in the market

Some of the key players in Healthcare EDI Market include McKesson Corporation, Cognizant, UnitedHealth Group, IBM, Experian Information Solutions, The SSI Group, Optum Inc., GE Healthcare, Cerner Corporation, Allscripts Healthcare Solutions, Veradigm LLC, NTT DATA Group Corporation, Comarch SA, Axway, Availity LLC, Quadax Inc., Waystar and Inovalon.

Key Developments:

In December 2024, McKesson Corporation reported that it has closed the transaction announced in September 2024 to sell its Canada-based Rexall and Well.ca businesses to Birch Hill Equity Partners, a Canadian private equity firm. This transaction enables the Company to focus capital deployment and prioritize investments expanding its strategic oncology and biopharma growth platforms.

In January 2023, UnitedHealth Group launched Optum's Intelligent EDI (iEDI) solution to help care providers submit medical claims easily, whether they are large health systems or small practices.

In October 2022, The SSI Group, LLC (SSI), a leading provider of revenue cycle management (RCM) solutions, today announced the launch of a turnkey, end-to-end electronic prior authorization solution for healthcare providers that connects in real-time to more than seven-hundred payers. SSI Prior Authorization, powered by Myndshft, automates the prior authorization process from beginning to end, eliminating friction while delivering immediate value in improving productivity, reducing unnecessary operating costs, and increasing revenue. Specifically for hospitals, the solution will provide prior authorization improvements enterprise-wide.

Transaction Types Covered:

  • Claims Management
  • Eligibility Verification
  • Patient Information Management
  • Pharmacy Data Exchange
  • Other Transaction Types

Components Covered:

  • Software Solutions
  • Services

Deployments Covered:

  • On-Premise EDI
  • Cloud-Based EDI

End Users Covered:

  • Healthcare Providers
  • Healthcare Payers
  • Clearinghouses
  • Other End Users

Regions Covered:

  • North America
    • US
    • Canada
    • Mexico
  • Europe
    • Germany
    • UK
    • Italy
    • France
    • Spain
    • Rest of Europe
  • Asia Pacific
    • Japan
    • China
    • India
    • Australia
    • New Zealand
    • South Korea
    • Rest of Asia Pacific
  • South America
    • Argentina
    • Brazil
    • Chile
    • Rest of South America
  • Middle East & Africa
    • Saudi Arabia
    • UAE
    • Qatar
    • South Africa
    • Rest of Middle East & Africa

What our report offers:

  • Market share assessments for the regional and country-level segments
  • Strategic recommendations for the new entrants
  • Covers Market data for the years 2022, 2023, 2024, 2026, and 2030
  • Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
  • Strategic recommendations in key business segments based on the market estimations
  • Competitive landscaping mapping the key common trends
  • Company profiling with detailed strategies, financials, and recent developments
  • Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

  • Company Profiling
    • Comprehensive profiling of additional market players (up to 3)
    • SWOT Analysis of key players (up to 3)
  • Regional Segmentation
    • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
  • Competitive Benchmarking
    • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

  • 2.1 Abstract
  • 2.2 Stake Holders
  • 2.3 Research Scope
  • 2.4 Research Methodology
    • 2.4.1 Data Mining
    • 2.4.2 Data Analysis
    • 2.4.3 Data Validation
    • 2.4.4 Research Approach
  • 2.5 Research Sources
    • 2.5.1 Primary Research Sources
    • 2.5.2 Secondary Research Sources
    • 2.5.3 Assumptions

3 Market Trend Analysis

  • 3.1 Introduction
  • 3.2 Drivers
  • 3.3 Restraints
  • 3.4 Opportunities
  • 3.5 Threats
  • 3.6 End User Analysis
  • 3.7 Emerging Markets
  • 3.8 Impact of Covid-19

4 Porters Five Force Analysis

  • 4.1 Bargaining power of suppliers
  • 4.2 Bargaining power of buyers
  • 4.3 Threat of substitutes
  • 4.4 Threat of new entrants
  • 4.5 Competitive rivalry

5 Global Healthcare EDI Market, By Transaction Type

  • 5.1 Introduction
  • 5.2 Claims Management
    • 5.2.1 Claims Submission
    • 5.2.2 Claims Status Inquiry
    • 5.2.3 Claims Payment
  • 5.3 Eligibility Verification
  • 5.4 Patient Information Management
  • 5.5 Pharmacy Data Exchange
  • 5.6 Other Transaction Types

6 Global Healthcare EDI Market, By Component

  • 6.1 Introduction
  • 6.2 Software Solutions
    • 6.2.1 EDI Solutions
    • 6.2.2 Integration Platforms
    • 6.2.3 Analytics Tools
  • 6.3 Services
    • 6.3.1 Implementation Services
    • 6.3.2 Support & Maintenance
    • 6.3.3 Training Services

7 Global Healthcare EDI Market, By Deployment

  • 7.1 Introduction
  • 7.2 On-Premise EDI
  • 7.3 Cloud-Based EDI

8 Global Healthcare EDI Market, By End User

  • 8.1 Introduction
  • 8.2 Healthcare Providers
    • 8.2.1 Hospitals
    • 8.2.2 Clinics
    • 8.2.3 Long-Term Care Facilities
  • 8.3 Healthcare Payers
    • 8.3.1 Insurance Companies
    • 8.3.2 Government Organizations
  • 8.4 Clearinghouses
  • 8.5 Other End Users

9 Global Healthcare EDI Market, By Geography

  • 9.1 Introduction
  • 9.2 North America
    • 9.2.1 US
    • 9.2.2 Canada
    • 9.2.3 Mexico
  • 9.3 Europe
    • 9.3.1 Germany
    • 9.3.2 UK
    • 9.3.3 Italy
    • 9.3.4 France
    • 9.3.5 Spain
    • 9.3.6 Rest of Europe
  • 9.4 Asia Pacific
    • 9.4.1 Japan
    • 9.4.2 China
    • 9.4.3 India
    • 9.4.4 Australia
    • 9.4.5 New Zealand
    • 9.4.6 South Korea
    • 9.4.7 Rest of Asia Pacific
  • 9.5 South America
    • 9.5.1 Argentina
    • 9.5.2 Brazil
    • 9.5.3 Chile
    • 9.5.4 Rest of South America
  • 9.6 Middle East & Africa
    • 9.6.1 Saudi Arabia
    • 9.6.2 UAE
    • 9.6.3 Qatar
    • 9.6.4 South Africa
    • 9.6.5 Rest of Middle East & Africa

10 Key Developments

  • 10.1 Agreements, Partnerships, Collaborations and Joint Ventures
  • 10.2 Acquisitions & Mergers
  • 10.3 New Product Launch
  • 10.4 Expansions
  • 10.5 Other Key Strategies

11 Company Profiling

  • 11.1 McKesson Corporation
  • 11.2 Cognizant
  • 11.3 UnitedHealth Group
  • 11.4 IBM
  • 11.5 Experian Information Solutions
  • 11.6 The SSI Group
  • 11.7 Optum Inc.
  • 11.8 GE Healthcare
  • 11.9 Cerner Corporation
  • 11.10 Allscripts Healthcare Solutions
  • 11.11 Veradigm LLC
  • 11.12 NTT DATA Group Corporation
  • 11.13 Comarch SA
  • 11.14 Axway
  • 11.15 Availity LLC
  • 11.16 Quadax Inc.
  • 11.17 Waystar
  • 11.18 Inovalon

List of Tables

  • Table 1 Global Healthcare EDI Market Outlook, By Region (2022-2030) ($MN)
  • Table 2 Global Healthcare EDI Market Outlook, By Transaction Type (2022-2030) ($MN)
  • Table 3 Global Healthcare EDI Market Outlook, By Claims Management (2022-2030) ($MN)
  • Table 4 Global Healthcare EDI Market Outlook, By Claims Submission (2022-2030) ($MN)
  • Table 5 Global Healthcare EDI Market Outlook, By Claims Status Inquiry (2022-2030) ($MN)
  • Table 6 Global Healthcare EDI Market Outlook, By Claims Payment (2022-2030) ($MN)
  • Table 7 Global Healthcare EDI Market Outlook, By Eligibility Verification (2022-2030) ($MN)
  • Table 8 Global Healthcare EDI Market Outlook, By Patient Information Management (2022-2030) ($MN)
  • Table 9 Global Healthcare EDI Market Outlook, By Pharmacy Data Exchange (2022-2030) ($MN)
  • Table 10 Global Healthcare EDI Market Outlook, By Other Transaction Types (2022-2030) ($MN)
  • Table 11 Global Healthcare EDI Market Outlook, By Component (2022-2030) ($MN)
  • Table 12 Global Healthcare EDI Market Outlook, By Software Solutions (2022-2030) ($MN)
  • Table 13 Global Healthcare EDI Market Outlook, By EDI Solutions (2022-2030) ($MN)
  • Table 14 Global Healthcare EDI Market Outlook, By Integration Platforms (2022-2030) ($MN)
  • Table 15 Global Healthcare EDI Market Outlook, By Analytics Tools (2022-2030) ($MN)
  • Table 16 Global Healthcare EDI Market Outlook, By Services (2022-2030) ($MN)
  • Table 17 Global Healthcare EDI Market Outlook, By Implementation Services (2022-2030) ($MN)
  • Table 18 Global Healthcare EDI Market Outlook, By Support & Maintenance (2022-2030) ($MN)
  • Table 19 Global Healthcare EDI Market Outlook, By Training Services (2022-2030) ($MN)
  • Table 20 Global Healthcare EDI Market Outlook, By Deployment (2022-2030) ($MN)
  • Table 21 Global Healthcare EDI Market Outlook, By On-Premise EDI (2022-2030) ($MN)
  • Table 22 Global Healthcare EDI Market Outlook, By Cloud-Based EDI (2022-2030) ($MN)
  • Table 23 Global Healthcare EDI Market Outlook, By End User (2022-2030) ($MN)
  • Table 24 Global Healthcare EDI Market Outlook, By Healthcare Providers (2022-2030) ($MN)
  • Table 25 Global Healthcare EDI Market Outlook, By Hospitals (2022-2030) ($MN)
  • Table 26 Global Healthcare EDI Market Outlook, By Clinics (2022-2030) ($MN)
  • Table 27 Global Healthcare EDI Market Outlook, By Long-Term Care Facilities (2022-2030) ($MN)
  • Table 28 Global Healthcare EDI Market Outlook, By Healthcare Payers (2022-2030) ($MN)
  • Table 29 Global Healthcare EDI Market Outlook, By Insurance Companies (2022-2030) ($MN)
  • Table 30 Global Healthcare EDI Market Outlook, By Government Organizations (2022-2030) ($MN)
  • Table 31 Global Healthcare EDI Market Outlook, By Clearinghouses (2022-2030) ($MN)
  • Table 32 Global Healthcare EDI Market Outlook, By Other End Users (2022-2030) ($MN)

Note: Tables for North America, Europe, APAC, South America, and Middle East & Africa Regions are also represented in the same manner as above.