Overview

Picture of health: Sweeping federal reform and an aging population will drive industry demand

IBISWorld’s Health & Medical Insurance market research report can be used to help you: understand market size and growth potential; major companies; draft business plans and pitch books; and conduct benchmarking and SWOT analysis. Our industry analysis highlights macro industry trends in the overall sector and micro trends faced by companies that do business in the industry. The industry report also provides key industry statistics and 5-year forecasts to anticipate future industry prospects so you can decide with confidence.

REPORT SNAPSHOT

Industry Threats & Opportunities

  • Industry revenue is correlated with total health expenditure, as operators increase premiums to maintain profitability
  • The aging US population has bolstered demand for health insurance coverage
  • Medical cost inflation and increased demand for medical insurance will dictate industry performance

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    Industry Analysis & Industry Trends

    Consistent increases in healthcare expenditure and medical cost inflation, as well as a sharp decline in the uninsured rate, have driven industry growth in recent years. Industry revenue is correlated with total health expenditure, as operators increase premiums to maintain profitability. Despite this revenue growth, medical cost increases and new legislation mandating minimum medical loss ratios have put pressure on industry profit. As a result, revenue is anticipated to increase over the five years to 2017, while profit margins are expected to decline slightly. Over the five years to 2022, revenue is forecast to rise. Other key sources of growth include medical cost inflation and increased demand from the aging US population...

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    Industry Report - Industry SWOT Analysis Chapter

    The Health and Medical Insurance Industry is in the mature stage of its economic life cycle; this stage is characterized by a slowdown in technological development and wholehearted market acceptance of the industry's products and services. Industry value added (IVA), which measures an industry's contribution to the overall economy, is expected to decrease an annualized 1.5% over the 10 years to 2022. In contrast, US GDP is projected to grow at an annualized rate of 2.0% during the same period. Industry IVA is decreasing mainly due to significant drops in profit margins caused by healthcare reforms.

    While there has been a substantial amount of industry-specific technology change over the five years to 2017, this has largely made administrative tasks more efficient. Con..

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    Additional Insights for the Health & Medical Insurance Industry

    IBISWorld identifies 250 Key Success Factors for a business.The most important for the Health & Medical Insurance Industry are

  • Having an extensive distribution/collection network
  • Having a good reputation
  • Ability to pass on cost increases
  • IBISWorld analysts also discuss how external factors such as Total health expenditure and Number of employees in the Health & Medical Insurance industry impact industry performance..

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    Industry Products

    What is the Health & Medical Insurance Industry?

    This industry underwrites (i.e. assumes the risks of and assigns premiums for) health and medical insurance policies. Insurance is the transfer of the risk of a loss in exchange for payment. Operators also provide administrative services for self-funded insurance plans (whereby an employer provides health benefits to workers with its own funds). Under this structure, the industry operator is a third-party administrator and is not responsible for health benefit payments.

    Industry Products
    Pharmacy benefit management (PBM)
    Preferred provider organization (PPO) plans
    High-deductible health plans (HDHPs)
    Health maintenance organization (HMO) plans
    Point-of-service (POS) plans
    Fee-for-service (FFS) plans
    Medicaid (via private companies)
    Medicare (via private companies)
    Industry Activities
    Underwriting health and medical insurance policies
    Underwriting dental policies
    Providing pharmacy benefit management services
    Managing care between the health provider and individual recipient
    Administering of self-funded insurance plans
    Investing health insurance premiums

    Table of Contents

    About this Industry
    Industry Definition
    Main Activities
    Similar Industries
    Additional Resources
    Industry at a Glance
    Industry Statistics Snapshot
    Industry Structure
    Executive Summary
    Industry Performance
    Executive Summary
    Key External Drivers
  • Total health expenditure
  • Number of employees
  • Median age of population
  • Number of physician visits
  • Per capita disposable income

  • Current Performance
  • Healthcare costs drive revenue
  • Demographic trends
  • Reform spurs acquisitions
  • Chart: Revenue Growth

  • Industry Outlook
  • Healthcare costs drive revenue
  • Demographic trends
  • Table: Health & Medical Insurance Industry Revenue Outlook

  • Industry Life Cycle
  • Life cycle reasons
  • Chart: Benchmarking - Health & Medical Insurance Industry Lifecycle vs The Economy

  • Products & Markets
    Supply Chains
    Key Buying Industries
  • Consumers

  • Key Selling Industries
  • Custody, Asset & Securities Services
  • Portfolio Management

  • Products & Services
  • Pharmacy benefit management (PBM)
  • Medicaid (via private companies)
  • Preferred provider organization (PPO) plans
  • Point-of-service (POS) plans
  • Medicare (via private companies)
  • High-deductible health plans (HDHPs)
  • Health maintenance organization (HMO) plans
  • Fee-for-service (FFS) plans
  • Chart: Health & Medical Insurance Industry Products and Services Segmentation

  • Demand Determinants
    Major Markets
  • Consumers with employer-sponsored health insurance
  • Consumers with Medicaid
  • Consumers with direct-purchased health insurance
  • Consumers with Medicare
  • Consumers with other insurance plans
  • Chart: Major Market Segmentation for the Health & Medical Insurance Industry

  • International Trade
    Business Locations
    Chart: Business Locations by State
    Competitive Landscape
    Market Share Concentration
    Key Success Factors
    Cost Structure Benchmarks
    ProfitHealthcare benefit expensesWagesOperating and other expenses
  • Chart: Cost Structure Benchmarking – Sector vs Health & Medical Insurance

  • Basis of Competition
    Barriers to Entry
  • Table: Barrier to Entry Checklist for the Health & Medical Insurance Industry

  • Industry Globalization
    Major Companies
    UnitedHealth Group Inc.Anthem Insurance Companies Inc.Aetna Inc. Humana Inc.
  • Table: UnitedHealth Group Inc. - financial performance
  • Table: Anthem Insurance Companies Inc. - financial performance
  • Table: Aetna Inc. - financial performance
  • Table: Humana Inc. - financial performance

  • Operating Conditions
    Capital Intensity
  • Chart: Level of Capital Intensity for the Health & Medical Insurance Industry
  • Chart: Tools of the Trade: Growth Strategies for Success

  • Technology & Systems
    Revenue Volatility
  • Chart: Volatility vs Industry Growth

  • Regulation & Policy
    Industry Assistance
    Key Statistics
    Table: Industry Data for the Health & Medical Insurance Industry
    Includes:
  • Industry Revenue (2008-2022)
  • Industry Gross Product (2008-2022)
  • Establishments (2008-2022)
  • Businesses (2008-2022)
  • Employment (2008-2022)
  • Wages (2008-2022)
  • Total Health Expenditure (2008-2022)

  • Table: Annual Percentage Change for Key Industry Data
    Table: Key Ratios for Industry Key Data
    Table: Industry Financial Ratios
    Jargon & Glossary
    Fully Funded Insurance
  • A type of coverage where a health insurer is financially responsible for paying all incurred benefits and administration costs of healthcare services. In return, the company receives a premium.
  • Health Maintenance Organization (Hmo)
  • A healthcare organization composed of physicians, hospitals or other providers that offer healthcare services at a reduced fee. Payment is made in advance, before services are rendered.
  • High-Deductible Health Plan
  • A health insurance plan that has a high-minimum deductible that does not cover the initial costs or all of the costs of medical expenses.
  • Indemnity Plan
  • A health plan with no preferred physician network that reimburses for medical expenses regardless of who provides the service. However, in some cases the reimbursement amount may be limited.
  • Managed Care
  • A general term that refers to the organization of doctors, hospitals and other providers into groups in order to enhance the quality and cost-effectiveness of healthcare.
  • Medical Loss Ratio
  • The ratio of premiums used to pay medical claims and improve the quality of care.
  • Point-Of-Service (Pos)
  • An HMO/PPO hybrid or "open-ended HMO" where members can choose which option (HMO or PPO) they will use each time they seek healthcare.
  • Preferred Provider Organization (Ppo)
  • A healthcare organization composed of physicians, hospitals or other providers that offer healthcare services at a reduced fee. Payment is made when services are rendered.
  • Self-Funded Insurance
  • A type of coverage where an employer or organization assumes complete responsibility for healthcare benefit payments instead of a health insurer.
  • Why buy this report?

    IBISWorld industry market research reports enable you to:
    • Find out about key industry trends
    • Identify threats and opportunities
    • Inform your decisions for marketing, strategy and planning
    • Quickly build competitive intelligence
    This report on Health & Medical Insurance:
    • Provides Market Size information to assist with planning and strategic decisions.
    • Includes the necessary information to perform SWOT, PEST and STEER analysis.
    • Helps you understand market dynamics to give you a deeper understanding of industry competition and the supply chain.
    • Analyses key performance and operational metrics so that you can benchmark against your own business, that of your customers’ businesses, or your competitors’ businesses.
    The Health & Medical Insurance market research report includes:
    • Historical data and analysis for the key drivers of this industry
    • A five-year forecast of the market and noted trends
    • Detailed research and segmentation for the main products and markets
    • An assessment of the competitive landscape and market shares for major companies
    • And of course, much more

    IBISWorld reports on thousands of industries around the world. Our clients rely on our information and data to stay up-to-date on industry trends across all industries. With this IBISWorld Industry Research Report on Health & Medical Insurance, you can expect thoroughly researched, reliable and current information that will help you to make faster, better business decisions.

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