健康保険TPAの米国市場、市場規模と予測（2021年～2031年）、国のシェア、動向、成長機会の分析：タイプ別、企業規模別

米国の健康保険TPAの市場規模は、2024年に649億2,000万米ドルであり、2031年までに1,448億6,000万米ドルに達すると予測され、2024年～2031年にCAGRで12.1%の成長を記録すると推定されます。市場の成長は、医療費の上昇、コスト削減を求める雇用者による自費保険プランの採用の増加、医療管理や規制遵守の複雑化、請求処理、アナリティクス、メンバーサポートなどの専門的な管理サービスへの需要の高まりなどの複数の要因によって促進されています。さらに、遠隔医療サービスや、雇用主が提供する医療制度の拡大、保険金請求処理における効率化の必要性、多様な医療ニーズに対してカスタマイズされたソリューションを提供するTPAの能力が、市場をさらに活性化させています。TPAにおけるAI主導のツールや自動化へのシフトも、保険企業や雇用主の業務を合理化し、全体的なコストを削減するTPAへの依存を高める一因となっています。

United States Census Bureauによると、2023年に米国人口の大多数、最大92.0%、3億520万人が少なくともその年の一部で健康保険に加入していました。民間の健康保険が65.4%をカバーし、公的保険は36.3%でした。雇用保険がもっとも広く普及しており、人口の53.7%をカバーし、メディケイドとメディケアがそれぞれ18.9%で続きました。その他の保険形式としては、直接購入保険が10.2%、TRICAREが2.6%、VA/CHAMPVAが1.0%でした。このような健康保険、特に雇用主が提供するプランの普及が、米国の健康保険TPA市場の成長に拍車をかけています。多くの雇用主が自費健康保険プランを提供する中、保険金請求処理、コンプライアンス、メンバーサービスなどの管理業務を担当するTPAへの需要は増加の一途をたどっています。

Sedgwick、Crawford and Company、CorVel Corp、UnitedHealth Group Inc、Arthur J Gallagher & Co、Meritain Health、EDISON HEALTH SOLUTIONS、ESIS、Cannon Cochran Management Services, Inc.、Heritage Health Solutionsは、この市場調査で紹介する企業の一部です。各社は新製品の発売、市場の拡大と多様化、買収戦略に注力しており、これにより機会にアクセスしています。

当レポートでは、米国の健康保険TPA市場について調査分析し、市場規模と予測、促進要因と抑制要因、競合情勢などの情報を提供しています。ｑ

目次

第1章 イントロダクション

第2章 エグゼクティブサマリー

• 重要考察

第3章 調査手法

第4章 米国の健康保険TPA市場情勢

• PEST分析
• エコシステム分析
  • 健康保険企業
  • TPA
  • 規制機関/政府機関
  • バリューチェーンのベンダーのリスト

第5章 米国の健康保険TPA市場 - 主な市場力学

• 米国の健康保険TPA市場 - 主な市場力学
• 市場促進要因
  • 医療費の高騰
  • 雇用主が提供する健康保険プランの拡大
• 市場抑制要因
  • データプライバシーとセキュリティに関する懸念
• 市場機会
  • 遠隔医療サービスの拡大
• 今後の動向
  • TPAにおけるAI主導のツールと自動化
• 促進要因と抑制要因の影響

第6章 米国の健康保険TPA市場の分析

• 米国の健康保険TPA市場の収益（2021年～2031年）
• 米国の健康保険TPA市場の予測と分析

第7章 米国の健康保険TPA市場の分析 - タイプ別

• 健康保険
• 障害保険
• 労災保険
• その他

第8章 米国の健康保険TPA市場の分析 - 企業規模別

• 大企業
• 中小企業

第9章 競合情勢

• 企業ヒートマップ分析
• 企業のポジショニングと集中度分析

第10章 産業情勢

• 市場戦略
• 新製品開発
• 合併と買収

第11章 企業プロファイル

• Sedgwick
• Crawford and Company
• CorVel Corp
• UnitedHealth Group Inc
• Arthur J Gallagher & Co
• Heritage Health Solutions, Inc.
• Edison Health Solutions
• Meritain Health
• Chubb Ltd
• Cannon Cochran Management Services Inc.

第12章 付録

List Of Tables

• Table 1. U.S Healthcare Insurance Third-Party Administrator Market Segmentation
• Table 2. List of Vendors
• Table 3. U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Table 4. U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million) - by Type
• Table 5. U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million) - by Enterprise Size
• Table 6. Company Positioning & Concentration

List Of Figures

• Figure 1. U.S Healthcare Insurance Third-Party Administrator Market Segmentation, by Country
• Figure 2. PEST Analysis
• Figure 3. Ecosystem Analysis
• Figure 4. Impact Analysis of Drivers and Restraints
• Figure 5. U.S Healthcare Insurance Third-Party Administrator Market Revenue (US$ Million), 2021-2031
• Figure 6. U.S Healthcare Insurance Third-Party Administrator Market Share (%) - by Type, 2024 and 2031
• Figure 7. Health Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 8. Disability Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 9. Workers Compensation Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 10. Others: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 11. U.S Healthcare Insurance Third-Party Administrator Market Share (%) - by Enterprise Size, 2024 and 2031
• Figure 12. Large Enterprises: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 13. SMEs: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• Figure 14. Heat Map Analysis

The US Healthcare Insurance Third-Party Administrator Market size was valued at US$ 64.92 billion in 2024 and is expected to reach US$ 144.86 billion by 2031. The market is estimated to record a CAGR of 12.1% from 2024 to 2031. The growth of the healthcare insurance third-party administrator market in the US is driven by several key factors, including the rising healthcare costs, increasing adoption of self-funded insurance plans by employers seeking cost savings, the growing complexity of healthcare management and regulatory compliance, and the rising demand for specialized administrative services such as claims processing, analytics, and member support. Additionally, the expansion of telehealth services and employer-sponsored health plans, the need for enhanced efficiency in claims adjudication, and the ability of third-party administrators to offer customized solutions for diverse healthcare needs further fuel the market. The shift toward AI-driven tools and automation in third-party administrators also contributes to the rising reliance on third-party administrators to streamline operations and reduce overall costs for insurers and employers.

According to the United States Census Bureau, in 2023, the majority of the US population, ~92.0% or 305.2 million people, had health insurance for at least part of the year. Private health insurance coverage remained the dominant form, covering 65.4% of individuals, while public coverage accounted for 36.3%. Employment-based insurance was the most widespread form, providing coverage for 53.7% of the population, followed by Medicaid and Medicare, both covering 18.9% of individuals. Other forms of coverage included direct-purchase insurance at 10.2%, TRICARE at 2.6%, and VA/CHAMPVA at 1.0%. This increasing prevalence of health insurance, particularly employer-sponsored plans, has fueled the growth of the healthcare insurance third-party administrator market in the US. As more employers offer self-funded health plans, the demand for third-party administrators to handle administrative tasks such as claims processing, compliance, and member services continues to rise.

Sedgwick; Crawford and Company; CorVel Corp; UnitedHealth Group Inc; Arthur J Gallagher & Co; Meritain Health; EDISON HEALTH SOLUTIONS; ESIS; Cannon Cochran Management Services, Inc.; and Heritage Health Solutions are among the key players profiled during this market study. The market players focus on new product launches, expansion and diversification, and acquisition strategies, which allow them to access prevailing business opportunities.

The overall US Healthcare Insurance Third-Party Administrator market analysis has been derived using both primary and secondary sources. To begin the US Healthcare Insurance Third-Party Administrator market research process, exhaustive secondary research has been conducted using internal and external sources to obtain qualitative and quantitative information related to the US Healthcare Insurance Third-Party Administrator market. The process also serves the purpose of obtaining an overview and market forecast for the US Healthcare Insurance Third-Party Administrator market growth with respect to all market segments. Also, multiple primary interviews have been conducted with industry participants and commentators to validate the data and gain more analytical insights about the topic. Participants of this process include industry experts such as VPs, business development managers, market intelligence managers, and national sales managers-along with external consultants such as valuation experts, research analysts, and key opinion leaders-specializing in the US Healthcare Insurance Third-Party Administrator market forecast.

Table Of Contents

1. Introduction

• 1.1 The Insight Partners Research Report Guidance
• 1.2 Market Segmentation

2. Executive Summary

• 2.1 Key Insights

3. Research Methodology

• 3.1 Secondary Research
• 3.2 Primary Research
  • 3.2.1 Hypothesis formulation:
  • 3.2.2 Macro-economic factor analysis:
  • 3.2.3 Developing base number:
  • 3.2.4 Data Triangulation:
  • 3.2.5 Country level data:

4. U.S Healthcare Insurance Third-Party Administrator Market Landscape

• 4.1 Overview
• 4.2 PEST Analysis
• 4.3 Ecosystem Analysis
  • 4.3.1 Healthcare Insurance Companies
  • 4.3.2 Third-Party Administrators
  • 4.3.3 Regulatory Bodies/Government Agencies
  • 4.3.4 List of Vendors in the Value Chain

5. U.S Healthcare Insurance Third-Party Administrator Market - Key Market Dynamics

• 5.1 U.S Healthcare Insurance Third-Party Administrator Market - Key Market Dynamics
• 5.2 Market Drivers
  • 5.2.1 Rising Healthcare Costs
  • 5.2.2 Growing Employer-Sponsored Health Plans
• 5.3 Market Restraints
  • 5.3.1 Data Privacy and Security Concerns
• 5.4 Market Opportunities
  • 5.4.1 Expansion of Telehealth Services
• 5.5 Future Trends
  • 5.5.1 AI-Driven Tools and Automation in Third-Party Administrators
• 5.6 Impact of Drivers and Restraints:

6. U.S Healthcare Insurance Third-Party Administrator Market Analysis

• 6.1 U.S Healthcare Insurance Third-Party Administrator Market Revenue (US$ Million), 2021-2031
• 6.2 U.S Healthcare Insurance Third-Party Administrator Market Forecast and Analysis

7. U.S Healthcare Insurance Third-Party Administrator Market Analysis - by Type

• 7.1 Health Insurance
  • 7.1.1 Overview
  • 7.1.2 Health Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• 7.2 Disability Insurance
  • 7.2.1 Overview
  • 7.2.2 Disability Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• 7.3 Workers Compensation Insurance
  • 7.3.1 Overview
  • 7.3.2 Workers Compensation Insurance: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• 7.4 Others
  • 7.4.1 Overview
  • 7.4.2 Others: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)

8. U.S Healthcare Insurance Third-Party Administrator Market Analysis - by Enterprise Size

• 8.1 Large Enterprises
  • 8.1.1 Overview
  • 8.1.2 Large Enterprises: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)
• 8.2 SMEs
  • 8.2.1 Overview
  • 8.2.2 SMEs: U.S Healthcare Insurance Third-Party Administrator Market - Revenue and Forecast to 2031 (US$ Million)

9. Competitive Landscape

• 9.1 Company Heat Map Analysis
• 9.1 Company Positioning & Concentration Analysis

10. Industry Landscape

• 10.1 Overview
• 10.2 Market Initiative
• 10.2 New Product Development
• 10.3 Mergers & Acquisitions

11. Company Profiles

• 11.1 Sedgwick
  • 11.1.1 Key Facts
  • 11.1.2 Business Description
  • 11.1.3 Products and Services
  • 11.1.4 Financial Overview
  • 11.1.5 SWOT Analysis
  • 11.1.6 Key Developments
  • 11.1.7 TPA Valuation
• 11.2 Crawford and Company
  • 11.2.1 Key Facts
  • 11.2.2 Business Description
  • 11.2.3 Products and Services
  • 11.2.4 Financial Overview
  • 11.2.5 SWOT Analysis
  • 11.2.6 Key Developments
  • 11.2.7 TPA Valuation
• 11.3 CorVel Corp
  • 11.3.1 Key Facts
  • 11.3.2 Business Description
  • 11.3.3 Products and Services
  • 11.3.4 Financial Overview
  • 11.3.5 SWOT Analysis
  • 11.3.6 Key Developments
  • 11.3.7 TPA Valuation
• 11.4 UnitedHealth Group Inc
  • 11.4.1 Key Facts
  • 11.4.2 Business Description
  • 11.4.3 Products and Services
  • 11.4.4 Financial Overview
  • 11.4.5 SWOT Analysis
  • 11.4.6 Key Developments
  • 11.4.7 TPA Valuation
• 11.5 Arthur J Gallagher & Co
  • 11.5.1 Key Facts
  • 11.5.2 Business Description
  • 11.5.3 Products and Services
  • 11.5.4 Financial Overview
  • 11.5.5 SWOT Analysis
  • 11.5.6 Key Developments
  • 11.5.7 TPA Valuation
• 11.6 Heritage Health Solutions, Inc.
  • 11.6.1 Key Facts
  • 11.6.2 Business Description
  • 11.6.3 Products and Services
  • 11.6.4 Financial Overview
  • 11.6.5 SWOT Analysis
  • 11.6.6 Key Developments
  • 11.6.7 TPA Valuation
• 11.7 Edison Health Solutions
  • 11.7.1 Key Facts
  • 11.7.2 Business Description
  • 11.7.3 Products and Services
  • 11.7.4 Financial Overview
  • 11.7.5 SWOT Analysis
  • 11.7.6 Key Developments
  • 11.7.7 TPA Valuation
• 11.8 Meritain Health
  • 11.8.1 Key Facts
  • 11.8.2 Business Description
  • 11.8.3 Products and Services
  • 11.8.4 Financial Overview
  • 11.8.5 SWOT Analysis
  • 11.8.6 Key Developments
  • 11.8.7 TPA Valuation
• 11.9 Chubb Ltd
  • 11.9.1 Key Facts
  • 11.9.2 Business Description
  • 11.9.3 Products and Services
  • 11.9.4 Financial Overview
  • 11.9.5 SWOT Analysis
  • 11.9.6 Key Developments
  • 11.9.7 TPA Valuation (ESIS)
• 11.10 Cannon Cochran Management Services Inc.
  • 11.10.1 Key Facts
  • 11.10.2 Business Description
  • 11.10.3 Products and Services
  • 11.10.4 Financial Overview
  • 11.10.5 SWOT Analysis
  • 11.10.6 Key Developments
  • 11.10.7 TPA Valuation

12. Appendix

• 12.1 Abbreviations
• 12.2 About The Insight Partners