醫療用EDI市場:現狀分析與未來預測 (2024年～2032年)

Healthcare EDI Market: Current Analysis and Forecast (2024-2032)

出版日期: 2025年01月01日 | 出版商:

UnivDatos Market Insights Pvt Ltd | 英文 142 Pages | 商品交期: 最快1-2個工作天內

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簡介目錄

預計預測期內（2024-2032 年），醫療 EDI 市場將以 9.46% 的複合年增長率大幅增長。醫療保健 EDI 成長和發展的主要驅動力是對醫療保健服務交付中營運效率的不斷增長的需求。醫療費用的上漲、索賠量的增加以及患者數據的不斷增長，都要求實現某些工作流程的自動化，以最大限度地降低成本和減少錯誤。此外，基於價值的照護趨勢推動了對 EDI 的需求，因為它是與索賠裁決、資格檢查和其他付款調整相關的交易的首選方法。此外，由於雲端主導和 API 整合等因素，EDI 的發展正在演變和擴大，使得 EDI 更加普及並提供即時資訊。遠距醫療服務的使用不斷增加、人口老化以及與其他醫療保健系統整合的需求正在推動醫療保健 EDI 市場的發展。

從組成部分來看，由於全球醫療服務提供者、保險公司、醫療 IT 供應商等擴大採用 EDI 軟體和平台，解決方案部門在醫療保健 EDI 市場中佔據了最大的市場佔有率。這些解決方案透過改進功能並遵守 HIPAA 法規來加快索賠處理、資格確定和支付交易。基於雲端的 EDI、API 整合和連接平台等現代解決方案的額外要求也加強了這一領域的案例。然而，隨著越來越多的組織開始採用更發達的 EDI 解決方案，對實施、整合和維護服務的需求持續上升，預計未來服務領域將以較高的速度擴張。此外，許多中小型供應商可能不具備使用 EDI 系統的內部技能，從而促使對培訓、諮詢和託管服務等外包服務的需求增加。訂閱式轉變和增值服務快速成長等趨勢可能會對未來幾年服務業的發展產生正面影響。

以交付方式劃分，EDI 加值網路 (VAN) 部分佔據整個醫療 EDI 市場的最大佔有率。 VAN 因其能夠提供安全統一的通訊管道並在醫療保健利益相關者（包括醫療保健提供者、付款人和清算機構）之間交換標準數據而被廣泛採用。它的可靠性、整合的合規選項以及易於解決複雜交易的特點使其成為大型醫療保健組織的理想選擇。然而，由於基於雲端的 EDI 領域具有高可擴展性、低營運成本和即時數據共享等特點，預計未來將實現大幅成長。基於雲端的 EDI 部署的規模比傳統結構和佈局具有多種優勢，尤其是對於中小型組織而言。這使得採用變得更加容易，特別是對於人工智慧等先進技術而言。由於越來越重視互通性、基於價值的護理和資料交換等問題，基於雲端的 EDI 領域預計將提供最多的未來成長機會。

根據最終用途，醫療保健付款人部門佔全球醫療保健 EDI 市場的最大佔有率，因為保險公司和其他政府第三方收款機構在帳單提交、驗證和付款對帳方面發揮著核心作用。此外，付款組織由於能夠在短時間內處理和傳輸大量交易，同時優先考慮機密性和標準化資料共享，因此有望佔據主導地位。然而，由於電子健康檔案、遠距醫療和綜合護理系統的採用不斷增加，預計未來提供者部分將成長最快。為了提高效率並減少錯誤，EDI 在醫療帳單、索賠提交和資格判定方面的應用越來越廣泛。對基於價值的護理的需求不斷增長和向以患者為中心的模式的轉變，以及對互通性的需求不斷增長，將繼續推動醫療保健提供者領域的成長。

為了更了解醫療 EDI 系統的市場採用情況，我們根據其在北美（美國、加拿大和北美其他地區）、歐洲（德國、法國、英國、西班牙、義大利和歐洲其他地區）、亞太地區（中國、日本、印度和亞太地區其他地區）和世界其他地區的全球影響力對其進行了分析。由於醫療支出的增加和醫療保健領域的數位化，尤其是在中國和印度等國家，預計亞太地區在預測期內（2024-2032 年）將實現顯著的複合年增長率。醫療 EDI 市場強調協作開發活動以改善產品開發。

該市場的主要參與者包括 OSP、Mckesson Corporation、NextGen Healthcare, Inc.、Cognizant Technology Solutions Corporation、Cleo Communications、Epicor Software Corporation、Effective Data、DataTrans Solutions Inc.、Greenway Health 和 United Health Group。

Health Care Electronic Data Interchange (EDI) is a standard and systemized process of sharing healthcare information electronically among users like providers, payers, patients, etc. It allows interoperability between systems of care by offering a layout of crucial information that may include claims, eligibility verification, payment details, and medical records using formats like ANSI X12 as well as HL7. Electronic data interchange is done by moving manual paperwork to paperless electronic transactions hence increasing workflow efficiency and decreasing cost and errors. It is employed in claims processing, prior authorization, remittance advice, and patient record exchange, making it the pulse of the modern healthcare system. Most of the EDI solutions are compatible with Electronic Health Records (EHR), practice management systems, and even clouds. EDI systems are also being extended with new technologies such as AI and blockchain to deliver greater accuracy and security to the data systems as well as better and improved forecast information. As healthcare continues to move online, EDI is critical for making processes more efficient, for providing better connectivity, and for the progression of the industry toward more value-based care and, therefore, better overall health outcomes for patients and performance for providers.

The Healthcare EDI Market is expected to grow with a significant CAGR of 9.46% during the forecast period (2024-2032). The key factors that contribute to the growth and development of healthcare EDI are a heightened requirement for operational efficiency in the delivery of healthcare services. Higher healthcare costs, a large number of claims, and growing accumulations of patient data create a demand for automating certain workflows to minimize costs and mistakes. Transmission towards value-based care also increases the need for EDI as it is an optimal way for claims adjudication as well as eligibility checks and other transactions pertaining to payment reconciliation. Moreover, EDI development is evolving and expanding, due to factors like cloud advantage and API integration, making it further reaching and offering real-time information. The increased use of telehealth services, the aging population, and the demand for integration with other healthcare systems boost the healthcare EDI market.

Based on the component segment, the solutions segment has the largest market share in the healthcare EDI market due to the increased adoption of EDI software and platforms by healthcare service providers, insurers, healthcare IT vendors, etc. across the globe. These solutions facilitate claim processing, eligibility determination, and payment transactions with improved capability and conformity to HIPAA rules. Additional requirements for modern solutions, including cloud-based EDI, API integrated, and connected platforms also increase the grounds for this segment. However, the services segment is expected to expand at a higher rate in the future due to the continually rising demand for implementation, integration, and maintenance services as more organizations embark on more developed EDI solutions. Moreover, many small- to medium-sized providers may not have the internal skills to handle EDI systems, resulting in an increased need for outsourcing services, including training, consulting, and managed services. The trend toward transition to subscription and quickly growing value-added services will positively affect the development of the services segment in the upcoming years.

Based on delivery mode, the EDI Value-Added Network (VAN) segment holds the largest market share in the overall healthcare EDI market. VANs are employed commonly due to their capability to deliver a protected and consolidated communication channel and for the trade of standard data between healthcare stakeholders such as providers, payers, and clearinghouses. Their reliability as well as the integrated compliance options and ease in settling complex transactions make them ideal for large healthcare organizations. However, the cloud-based EDI segment is expected to grow significantly in the future due to its high scalability, cheaper cost of operation, and real-time data sharing. The scale of implementation of cloud-based EDI gives several advantages over traditional structures and layouts, especially for small and medium-sized organizations. This makes its adoption easier, especially with advanced technologies like artificial intelligence. Due to an increasing emphasis on issues such as interoperability, value-based care, and data exchange, the cloud-based EDI segment is considered to provide the most future growth opportunities.

Based on the end-use, The healthcare payers segment occupies the largest share in the global market for healthcare EDI since insurers and other government third-party recoveries play a central role in claim submission, verification, and payment reconciliation. Another factor that strengthens the leading position of payers is the ability to process and transmit a large number of transactions within a short period while prioritizing confidentiality and sharing standardized data. However, the Healthcare Providers segment is like to show the fastest growth in the future due to the rising adoption of EHRs, Telemedicine, and Integrated Healthcare systems. The use of EDI is becoming widespread in medical billing, claims filing, and eligibility verdicts so as to enhance efficiency and minimize mistakes. Increasing demands toward a shift to value-based care and patient-centered models and the increasing need for Interoperability will continue to fuel the growth in the Provider segment.

For a better understanding of the market adoption of healthcare EDI systems is analyzed based on its worldwide presence in countries such as North America (U.S., Canada, and the Rest of North America), Europe (Germany, France, U.K., Spain, Italy, Rest of Europe), Asia-Pacific (China, Japan, India, Rest of Asia-Pacific), Rest of World. Asia-Pacific is expected to grow with a significant CAGR in the forecast period (2024-2032) owing to the increased healthcare expenditure and digitalization in the healthcare sector especially in countries like China and India. The emphasis is made on the development of collaboration activities to improve product development in the healthcare EDI market.

Some of the major players operating in the market include OSP, Mckesson Corporation, NextGen Healthcare, Inc., Cognizant Technology Solutions Corporation, Cleo Communications, Epicor Software Corporation, Effective Data, DataTrans Solutions Inc., Greenway Health, United Health Group.

1.MARKET INTRODUCTION

1.1. Market Definitions
1.2. Main Objective
1.3. Stakeholders
1.4. Limitation

2.RESEARCH METHODOLOGY OR ASSUMPTION

2.1. Research Process of the Healthcare EDI Market
2.2. Research Methodology of the Healthcare EDI Market
2.3. Respondent Profile

3.EXECUTIVE SUMMARY

3.1. Industry Synopsis
3.2. Segmental Outlook
- 3.2.1. Market Growth Intensity
3.3. Regional Outlook

4.MARKET DYNAMICS

4.1. Drivers
4.2. Opportunity
4.3. Restraints
4.4. Trends
4.5. PESTEL Analysis
4.6. Demand Side Analysis
4.7. Supply Side Analysis
- 4.7.1. Partnerships & Collaborations
- 4.7.2. Investment Scenario

5.PRICING ANALYSIS

5.1. Regional Pricing Analysis
5.2. Price Influencing Factors

6.GLOBAL HEALTHCARE EDI MARKET REVENUE (USD BN), 2022-2032F

7.MARKET INSIGHTS BY COMPONENT

7.1. Services
7.2. Solutions

8.MARKET INSIGHTS BY DELIVERY MODE

8.1. Direct EDI
8.2. Mobile EDI
8.3. EDI value-added network (VAN)
8.4. Web and Cloud-based EDI

9.MARKET INSIGHTS BY END-USE

9.1. Healthcare Payers
9.2. Healthcare Providers
9.3. Pharmaceutical & Medical Device Industries
9.4. Others

10.MARKET INSIGHTS BY REGION

10.1. North America
- 10.1.1. U.S.
- 10.1.2. Canada
- 10.1.3. Rest of North America
10.2. Europe
- 10.2.1. Germany
- 10.2.2. U.K.
- 10.2.3. France
- 10.2.4. Italy
- 10.2.5. Spain
- 10.2.6. Rest of Europe
10.3. Asia-Pacific
- 10.3.1. China
- 10.3.2. Japan
- 10.3.3. India
- 10.3.4. Rest of Asia-Pacific
10.4. Rest of World

11.VALUE CHAIN ANALYSIS

11.1. Marginal Analysis
11.2. List of Market Participants

12.COMPETITIVE LANDSCAPE

12.1. Competition Dashboard
12.2. Competitor Market Positioning Analysis
12.3. Porter Five Forces Analysis

13.COMPANY PROFILES

13.1. OSP
- 13.1.1. Company Overview
- 13.1.2. Key Financials
- 13.1.3. SWOT Analysis
- 13.1.4. Product Portfolio
- 13.1.5. Recent Developments
13.2. Mckesson Corporation
13.3. NextGen Healthcare, Inc.
13.4. Cognizant Technology Solutions Corporation
13.5. Cleo Communications
13.6. Epicor Software Corporation
13.7. Effective Data
13.8. DataTrans Solutions Inc.
13.9. Greenway Health
13.10. United Health Group