Rising aggregate health expenditure will outweigh the decline of HMO penetration
(PRWEB) November 13, 2014
A declining share of the employer-sponsored health insurance market has outweighed gains in Medicare Advantage (MA) penetration for the HMO Providers industry. Industry operators provide HMO insurance coverage that supplies clients with physicians and other medical staff primarily engaged in providing a range of outpatient medical services, with a general focus on primary healthcare. In recent years, HMOs have consistently lost ground in the provision of employer-based coverage. Largely a result of this trend, industry revenue is expected to fall at an annualized rate over the five years to 2014.
Alternative to the employer-based market, HMO providers have consistently dominated the MA market. The dominance of HMOs in the MA market is partially related to urbanization trends. According to IBISWorld Industry Analyst Leah Goddard, “This trend is partially explained by the structure of HMOs, as it is easier to create closed provider networks in urban areas, given the range of providers in these locations.” Fortunately for industry operators, more than half of Medicare beneficiaries eligible to enroll in a MA plan live in metropolitan areas.
Over the five years to 2019, industry revenue is forecast to rise. During this period, rising aggregate health expenditure is anticipated to outweigh the continued decline of HMO penetration in the employer-sponsored insurance market. More specifically, total domestic health expenditure is forecast to rise at a sharp annualized rate from 2014 to 2019. “Typically, medical cost inflation is passed onto consumers in the form of increased premium rates; this allows industry operators to maintain profit margins,” says Goddard. However, rising wage costs, an increase in care utilization and the impact of the healthcare reform are still anticipated to damage the industry's profit margins in the years ahead.
For more information, visit IBISWorld’s HMO Providers in the US industry report page.
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IBISWorld industry Report Key Topics
This industry provides HMO insurance coverage that supplies clients with physicians and other medical staff primarily engaged in providing a range of outpatient medical services with a focus generally on primary healthcare.
Key External Drivers
Industry Life Cycle
Products & Markets
Products & Services
Globalization & Trade
Market Share Concentration
Key Success Factors
Cost Structure Benchmarks
Barriers to Entry
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