The global healthcare EDI market size is expected to grow from USD 3.13 billion in 2020 to USD 4.74 billion by 2026 at a CAGR of 7.1%.
The growth of this market is largely due to the development of transactional regulation regulations, the growing need to reduce health care costs, and government support for the implementation of HCIT. In addition, the need for better management of electricity claims and the payment of fees to health care providers are expected to create a growing demand in the Healthcare EDI market during the forecast period.
The current COVID-19 epidemic has caused a large number of patients to visit health facilities daily. According to WHO data, there have been 62.3 million confirmed cases of COVID-19 and 1.4 million deaths worldwide, as of November 30, 2020. As a result of the COVID-19 outbreak, the number of patient cases worldwide has increased. With the COVID-19 epidemic, many countries, including the whole of Europe, the US, India, and Australia, among others, are following complete locks across the country. These closures and limitations related to social segregation have also led to an increase in the use of Healthcare EDI solutions that help by exchanging patient data between health care providers and payers.
The Healthcare Insurance Portability and Accountability Act (HIPAA), passed in 1996, set the standard for transferring insurance information. Before this action, there were 400 different standards of treatment that not only made it difficult for providers and payers to process claims but also brought many errors that made it necessary to apply the claims management standard. EDI has streamlined the claims management process, the entire process being computerized with software that meets HIPAA's electronic filing requirements. The Patient Protection and Affordability Care Act, also known as the Obamacare Act, was passed in 2010 in the US The law aimed to increase access to and quality health insurance and authorized 834 EDI transactions for health care providers and payers. Its purpose is to transmit registration and non-registration information electronically. This initiative is a major factor in the adoption of EDI in the US healthcare industry.
Although the adoption of Healthcare EDI by health care providers is increasing, the costs associated with the installation of EDI software are high. The main reason for this includes third-party solutions and insufficient internal systems and clearing houses that add to the high cost of transactions with expensive setup. This will greatly affect the total cost of ownership. In developed markets throughout Europe and North America, the acceptance of EDI solutions has been low among small and medium healthcare providers mainly due to the high investment required in the use of EDI. Many health care providers and young adults look at the obvious cost of using EDI over the tangible benefits, which prevents them from using EDI solutions.
EDI outsourcing is the process of having a third party manage part or all of the process of using EDI to exchange information with trading partners. The rising cost of health care is increasingly pressuring the healthcare industry to provide quality care at a lower cost by reducing waste in each category. Loss of health care revenue in American hospitals due to self-payment problems reach 20% to 30%. In addition, according to a 2014 Ponemon Institute study, 577 health workers, doctors, and hospitals in the US have shown a lack of use of the latest mobile devices and online services to deliver patient care. As a result, US hospitals absorb an estimated $ 8.3 billion annually, while battling security and privacy concerns arising from media coverage at a time when organizational rules allow for higher penalties for violating patient privacy. For hospitals, this makes the issuance of billing and demanding services for EDI service providers an attractive proposal.
In addition to its long-term benefits, EDI has seen limited success. The reason for this lies in the situation of hospitals using Healthcare EDI and the health organizations that need it. The desired/ end-user users are very small participants, have limited IT resources, and do not suffer from limited financial resources; this prevents them from getting EDI. Unlike the world of marketing, in health care, major providers advocate the use and use of EDI for health. While these major retailers have the necessary equipment and budgets for the supply and use of EDI for health, hospitals and facilities are often overcrowded and have IT resources, making EDI healthcare risky and time-consuming. This resource shortage problem, which is mandated by the use of solutions, means that finding effective Healthcare EDI solutions can be a challenge.
By delivery mode, partially, the mobile EDI segment is expected to grow at the highest CAGR at the time of forecasting. Factors contributing to the high growth rate of this sector include technological advances in the healthcare industry and the increasing adoption of innovative solutions among healthcare providers.
By product and service, the services segment is expected to witness a rapid growth rate in the market due to factors such as the increasing number of claims, increasing difficulties, and the scale of EDI solutions, as they require extensive training programs. Similarly, the growing trend of outsourcing, such as revenue cycle management, claims management and management, and partner management services is also expected to stimulate the growth of the services market.
By transaction type, the Healthcare EDI market is divided into claims management and healthcare supply chain. The claims management segment is expected to account for the largest share in the EDI market for health care during climate change. A large proportion of this phase may be due to the increasing acceptance of EDI services by healthcare providers and payers as well as the need to meet legal requirements.
By end-user, the Healthcare EDI market is divided into healthcare providers, healthcare payers, medical device & pharmaceutical industries, and pharmacies. The proportion of health care providers is expected to grow at a very high CAGR during the forecast period due to the growing number of independent insurance players in the market.
Asia-Pacific is expected to grow at a higher CAGR during the forecast period. The increase in chronic diseases and the increase in the number of adults, the growing demand for high-quality health care systems due to increased per capita income in the region, and the growing awareness of EDI healthcare solutions among health care providers and payers are responsible for the highest CAGR of Asia- Pacific Healthcare EDI market.
The major players in the global Healthcare EDI market are McKesson Corporation (US), Allscripts Healthcare Solutions Inc. (US), Optum (US), athenahealth (US), Nextgen Healthcare (US), SSI Group, LLC (US), Cerner Corporation (US), Comarch SA (Poland), Cognizant Technology Corporation (US), Axway Software SA (France), Dell Technologies Inc. (US), Nextgen Healthcare (US), Synnex Corporation (US), Plexis Healthcare Systems (US), and Comarch (Poland).