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市场调查报告书
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1662890

2030 年医疗保健 EDI 市场预测：按交易类型、组件、部署、最终用户和地区进行的全球分析

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个工作天内

价格

根据 Stratistics MRC 的数据，全球医疗保健 EDI 市场预计在 2024 年达到 45 亿美元，到 2030 年将达到 81 亿美元，预测期内的复合年增长率为 10.3%。

医疗保健 EDI（电子资料交换）是一种允许电脑系统交换和使用资讯的系统。具体来说，在医疗保健领域，它描述了医院、保险公司和政府机构等各种医疗保健组织之间交换医疗保健资料的标准格式。医疗保健索赔交易、发票、病患资料、处方笺等可以按照定义的格式和程序安全地交换。

根据澳洲数位健康机构预测，2022年7月将有1.182亿次远距医疗服务惠及1,800万人，目前约有9.5万名医护人员正在使用远距医疗服务。

对效率和降低成本的需求日益增加

医疗保健 EDI 市场受提高业务效率和降低成本的需求所驱动。 EDI 可自动执行索赔处理、计费和保险验证等管理业务，消除人工错误并节省时间。这种效率将减少人事费用和纸张成本等业务费用，同时也透过更快的资料处理改善现金流。由于医疗保健组织面临成本上升和改善资源配置的需求，EDI 提供了一种可扩展的解决方案，可简化工作流程并优化资源利用率，使其成为市场成长的主要驱动力。

互通性问题

互通性挑战阻碍了 EDI 系统与现有医疗保健IT基础设施的无缝整合。不同的资料标准、过时的旧有系统以及 HL7 和 FHIR 等通讯协定的不一致实现相关人员之间的资料交换变得复杂。这些问题增加了成本并减缓了采用速度，特别是对于资源有限的小型医疗保健提供者。克服这些障碍需要在标准化工作和客製化解决方案方面进行大量投资，儘管 EDI 具有潜在优势，但这可能会减缓市场成长。

API 集成

API 和 EDI 系统的整合实现了即时资料交换和不同系统之间的无缝连接，从而带来了巨大的成长机会。 API 透过自动化工作流程、减少错误和提高交易速度来增强索赔管理流程。这项创新支持了医疗保健领域日益增长的互通性需求，同时解决了传统 EDI 系统的限制。随着医疗保健机构越来越多地采用云端基础的平台等先进技术，API 整合有望提高效率并扩大市场应用。

资料外洩和网路攻击

由于电子交换的患者资讯的敏感性，资料外洩对医疗保健 EDI 市场构成了重大威胁。针对EDI系统的网路攻击可能导致未授权存取、财务损失和声誉损害。实施强有力的安全措施的高成本进一步加剧了这项挑战。

COVID-19 的影响

COVID-19 疫情加速了远距医疗和远端监控等数位解决方案的采用，对医疗保健 EDI 市场产生了重大影响。社交距离措施增加了对电子资料交换的需求，以简化索赔处理并减少行政负担。然而，供应链中断和资金限制导致一些地区的推广速度减慢。儘管存在这些挑战，但这场疫情凸显了高效资料管理的重要性，并将 EDI 定位为未来以成本控制和技术进步为重点的医疗改革的重要工具。

预测期内，本地 EDI 市场规模预计将达到最大

由于本地 EDI 领域管理敏感医疗资料的能力强，预计在预测期内将占据最大的市场占有率。具有增强安全功能的内部部署解决方案是首选，尤其是在处理大量患者记录和索赔资料时。这些系统受到大型医院和保险公司的青睐，因为它们需要强大的基础设施来满足 HIPAA 等合规标准。虽然初始成本高于云端基础的替代方案，但其可靠性和客製化选项使其成为复杂的医疗保健业务必不可少的。

预计预测期内医疗保健提供者将以最高的复合年增长率成长。

预计医疗保健提供者在预测期内将经历最高的成长率。这是因为他们依靠 EDI 来自动化索赔处理、裁决和付款工作流程。透过减少管理成本和错误，EDI 使付款人能够有效地处理大量交易。对基于价值的护理模式的日益关注，使得寻求简化业务同时改善患者治疗效果的付款人对先进的资料交换解决方案的需求越来越大。

比最大的地区

在预测期内，北美预计将占据最大的市场占有率，这得益于其先进的医疗保健基础设施、电子健康记录(EHR) 的广泛采用以及 HIPAA 等法规。该地区正看到 McKesson Corporation 和 Optum Inc. 等大型公司对技术进行大量投资，以提高系统之间的互通性。成熟的保险网络也巩固了北美在该市场的主导地位。

复合年增长率最高的地区

由于中国和印度等国家的医疗保健系统快速数位化，预计亚太地区在预测期内将呈现最高的复合年增长率。政府推动医疗保健 IT 应用的倡议和对高效索赔管理解决方案的不断增长的需求正在推动该地区市场的成长。医疗旅游业的扩张和对电子资料交换优势的认识不断提高，进一步促进了亚太地区成为医疗保健 EDI 高成长地区的地位。

免费客製化服务

订阅此报告的客户可享有以下免费自订选项之一：

  • 公司简介
    • 对其他市场参与企业（最多 3 家公司）进行全面分析
    • 主要企业的 SWOT 分析（最多 3 家公司）
  • 地理细分
    • 根据客户兴趣对主要国家进行市场估计、预测和复合年增长率（註：基于可行性检查）
  • 竞争性基准化分析
    • 根据产品系列、地理分布和策略联盟对主要企业基准化分析

目录

第一章执行摘要

第 2 章 前言

  • 概述
  • 相关利益者
  • 研究范围
  • 调查方法
    • 资料探勘
    • 资料分析
    • 资料检验
    • 研究途径
  • 研究资讯来源
    • 主要研究资讯来源
    • 二手研究资料资讯来源
    • 先决条件

第三章 市场走势分析

  • 介绍
  • 驱动程式
  • 限制因素
  • 机会
  • 威胁
  • 最终用户分析
  • 新兴市场
  • COVID-19 的影响

第 4 章 波特五力分析

  • 供应商的议价能力
  • 买家的议价能力
  • 替代品的威胁
  • 新进入者的威胁
  • 竞争对手之间的竞争

5. 全球医疗保健 EDI 市场按交易类型划分

  • 介绍
  • 索赔管理
    • 提交索赔
    • 查询理赔状态
    • 保险付款
  • 资格验证
  • 病患资讯管理
  • 药房资料交换
  • 其他的

6. 全球医疗保健 EDI 市场（按组件划分）

  • 介绍
  • 软体解决方案
    • EDI 解决方案
    • 整合平台
    • 分析工具
  • 服务
    • 实施服务
    • 支援和维护
    • 培训服务

第 7 章 全球医疗保健 EDI 市场（按部署）

  • 介绍
  • 本地 EDI
  • 云端基础的EDI

第 8 章 全球医疗保健 EDI 市场（按最终用户）

  • 介绍
  • 医疗保健提供者
    • 医院
    • 诊所
    • 长期照护机构
  • 医疗保健付款人
    • 保险公司
    • 政府
  • 清算所
  • 其他的

9. 全球医疗保健 EDI 市场（按地区）

  • 介绍
  • 北美洲
    • 美国
    • 加拿大
    • 墨西哥
  • 欧洲
    • 德国
    • 英国
    • 义大利
    • 法国
    • 西班牙
    • 其他欧洲国家
  • 亚太地区
    • 日本
    • 中国
    • 印度
    • 澳洲
    • 纽西兰
    • 韩国
    • 其他亚太地区
  • 南美洲
    • 阿根廷
    • 巴西
    • 智利
    • 南美洲其他地区
  • 中东和非洲
    • 沙乌地阿拉伯
    • 阿拉伯聯合大公国
    • 卡达
    • 南非
    • 其他中东和非洲地区

第十章 主要进展

  • 协议、伙伴关係、合作和合资企业
  • 收购与合併
  • 新产品发布
  • 业务扩展
  • 其他关键策略

第十一章 公司概况

  • 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.