医療保険の米国市場：成長機会

米国はGDPの18%以上を医療に費やす世界最大の医療市場です。米国の医療事情は進化を続けており、テレヘルス、バーチャルケア、在宅ケアなどのモデルが成長しており、こうした変化は、米国の医療提供や償還モデルに影響を与えるだけでなく、支払者、在宅医療機関、メドテック企業など、さまざまな関係者に新たな機会をもたらしています。

当レポートでは、米国の医療保険市場について調査分析し、戦略的必須要件、メディケアの概要、メディケイドの概要、成長機会等に関する情報を提供しています。

目次

戦略的必須要件

• 成長がますます困難になるのはなぜか？
• 戦略的必須要件 8（TM）
• 米国の医療保険業界に対する上位3つの戦略的必須要件の影響
• 成長機会がGrowth Pipeline Engine (TM)を促進

米国の支払者エコシステムの概要

• 米国の医療費支払者権限
• 2022年の支払者エコシステム
• 米国の医療費支払者のための重要な規制
• メディケイド拡大（ACA）
• 成長の促進要因
• 成長の抑制要因

メディケア（医療保険制度）の概要

• メディケア
• 標準的なメディケアvs.メディケアアドバンテージ（メディケアパートC）-2022年
• メディケア-メディケイド（Medi-Medi）受益者

メディケイドの概要

• メディケイドの概要
• メディケイドの範囲
• 長期的ケアのためのメディケイド

企業向け医療保険の概要

• 企業向け医療保険

支払者に影響を与える動向

• 幅広い動向と技術イニシアチブ：支払者別

成長機会ユニバース

• 成長機会1-在宅需要に対応するポータブルおよび小型医療機器の新時代
• 成長機会2-バーチャルケアの成長とPDGMに対応し、患者構成と診療報酬を進化させる在宅医療の代理店事業
• 成長機会3-在宅病院：在宅サービス、支払者、ヘルスケア施設、および医師グループのケアのための主要な成長アベニュー
• 図表リスト
• 免責事項

Transitional Care Delivery Models and Payer Policies Redefining Stakeholders' Future Growth Strategies

The United States is the world's largest healthcare market, spending over 18% of its GDP on healthcare. Therefore, it is important for healthcare stakeholders to understand how the US healthcare market functions, primarily its insurance system. The US health insurance landscape has seen significant evolution through various legislations, ranging from the 1940s laws that established the Centers for Medicare and Medicaid Services (CMS) to the Affordable Care Act of 2010. More importantly, the insurance landscape has not been immune to the far-reaching impacts of the COVID-19 pandemic on how the payer community will operate in the future. The US healthcare landscape continues to evolve, leading to the growth of telehealth, virtual care, and home care models. These changes not only affect care delivery and reimbursement models in the United States, but also bring new opportunities for various stakeholders, including payers, home health agencies, and medtech companies.

This study provides an overview of the US healthcare payer landscape and the emerging trends impacting this space, resulting in a slew of opportunities for growth in this evolving landscape.

Table of Contents

Strategic Imperatives

• Why Is It Increasingly Difficult to Grow?
• The Strategic Imperative 8™
• The Impact of the Top Three Strategic Imperatives on the US Health Insurance Industry
• Growth Opportunities Fuel the Growth Pipeline Engine™

US Payer Ecosystem Overview

• US Healthcare Payer Authority
• 2022 Payer Ecosystem
• Important Regulations for US Healthcare Payers
• Important Regulations for US Healthcare Payers (continued)
• Medicaid Expansion (ACA)
• Growth Drivers
• Growth Restraints

Overview of Medicare

• Medicare
• Standard Medicare vs Medicare Advantage (Medicare Part C)-2022
• Medicare-Medicaid (Medi-Medi) Beneficiaries

Overview of Medicaid

• Medicaid Overview
• Medicaid Coverage
• Medicaid for Long-Term Care

Overview of Commercial Health Insurance

• Commercial Health Insurance

Trends Impacting Payers

• Broad Trends and Technology Initiatives by Payers

Growth Opportunity Universe

• Growth Opportunity 1-New Era of Portable and Smaller Medical Devices to Address Hospital at Home Demand
• Growth Opportunity 1-New Era of Portable and Smaller Medical Devices to Address Hospital at Home Demand (continued)
• Growth Opportunity 2-Home Health Agency Business to Evolve Patient Mix and Reimbursement in Response to Virtual Care Growth and PDGM
• Growth Opportunity 2-Home Health Agency Business to Evolve Patient Mix and Reimbursement in Response to Virtual Care Growth and PDGM (continued)
• Growth Opportunity 3-Hospital at Home a Major Growth Avenue for Care at Home Services, Payers, Healthcare Facilities, and Physician Groups
• Growth Opportunity 3-Hospital at Home a Major Growth Avenue for Care at Home Services, Payers, Healthcare Facilities, and Physician Groups (continued)
• List of Exhibits
• Legal Disclaimer