Health
insurance exchange (HIX) is the latest trend in an online market place. Recent
market trends indicate that the global online health insurance marketplace or
exchanges industry is estimated at around USD 2 billion as reported by Forbes.
The key
drivers identified for this market include federal health insurance mandates,
policies (Obama Care Policy in the U.S.), and numerous funding sources from
federal governments. The shift in trend towards contributing model is expected
to help reduce health care costs and benefit consumers by making it affordable.
The growing
application of IT in the health sector and the shift in trend towards
integrated environments, among several other growth factors have ensured that
cloud-based technology is expected to provide lucrative opportunities in the
HIX market.
According to
the Affordable Care Act (ACA), HIX is a key provision that helps to establish a
selection or a list of vendors competing by diverse offerings such as qualified
plans.
These
qualified plans are designed to meet standards which are set by the ACA. Stiff
competition between the providers is also likely to encourage them to provide
improved quality and pricing of the offered plans.
The strategy
is practically carried out through online portals where consumers visit virtual
‘shops’ for their health insurances. Those people who qualify for cost-sharing
subsidies or premium subsidies can obtain these grants via these online portals
in various HIX schemes.
The concept
of HIX has originated from the heart of Obama Care in the U.S. An array of
online shopping centers filled with medical benefits have been created under
the program, and the idea was commercialized in 2010.
The motive
behind this online commercial insurance selling and buying are to create an
expedient for medical coverage by dismissing airplane tickets. It is done to
avoid bringing insurance companies together which compete among each other to
prevent affordable plans.
The health
insurance business transaction is carried out in three phases. The
implementation phase dominated the global HIX market in terms of revenue in
recent years.
The
operation and maintenance phase help to determine the potential market growth,
which is measured in terms of increased post implementation requirements, which
includes facility support, systems management, network operations, hardware and
software upgrades, trouble reporting, troubleshooting, storage management,
system performance reporting and monitoring and disaster recovery services.
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The HIX
industry is mainly driven by third party administrators (TPA), brokerages,
consultancies and firms catering to diverse end-use industries.HIX has several
components including services and software, which is expected to gain higher
revenues as compared to hardware components.
Periodic or
routine upgrades of different modules and functions of the software components
to foster compatibility are likely to spur segment growth. Compatibility requires
the installation of additional features, and information on recurring nature of
services which are necessary for ongoing reports. The compatibility framework
also checks the increased shift from legacy mainframes to the cloud and Saas
IT-enabled business models.
IT vendors
generate the highest revenue for the HIX market, measured regarding several
components such as planning, designing, implementation of exchanges, system
integration, program management, operations, and maintenance.
However,
factors such as data privacy, security issues, high capital investments, lack
of awareness especially for the private exchanges, the complex set of
technologies and changing regulations are expected to thwart industry growth.
Lack of skilled manpower regarding knowledge on healthcare domain and technical
expertise may also pose a challenge to market growth over the forecast period.
The global
industry has been segmented by type, phase, component, end-use industries and
geography. By type, the market is further divided into public and private
exchanges.
By stage,
the market is divided into pre-implementation phase, implementation phase or
infrastructure delivery, program management, independent validation and
verification (IV &V) which includes quality assurance (QA), operations and
maintenance.
By
component, the global market is divided into services, software and hardware.
Based on end user the market is further divided into government agencies, third
parties, brokerage firms, health plans/players. Major regions covered in this
report include North America, Europe, Asia and the rest of the world (RoW).
The U.S.
occupies highest share in the global industry and is expected to continue
dominating the global market over the forecast period. North America is also
likely to witness highest CAGR on account of increased adoption of private
health exchanges among increasingly aware consumers.
Currently,
Asia, Europe, and RoW do not have a considerable stake in this market. However,
rising adoption of HCIT (Healthcare Information Technology) and HIE (Health
Insurance Exchange) and increased outsourcing are likely to generate higher
revenues over the forecast period.
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