Health Insurance Carriers Industry Profile

The US managed health insurance industry includes about 1,000 companies with combined annual revenue of about $500 billion. Major companies include Aetna, UnitedHealth Group, and Humana, as well as the Blue Cross and Blue Shield Association and Kaiser Permanente. The industry is highly concentrated: the 50 largest companies generate about 75 percent of revenue.

Globally, health care services are either provided by the government or paid for by individuals. Global demand for private medical insurance is rising, however, especially in developing countries with a growing middle class such as India and China.

COMPETITIVE LANDSCAPE

Demand for health insurance products is driven by the rising costs of medical care. The profitability of individual companies depends on efficient operations and the ability to negotiate favorable contracts with health care providers. Large companies and organizations have advantages in negotiating contracts with health care providers. Small companies can compete successfully by providing special coverage plans as part of government programs such as Medicaid, or for specialized populations. The industry is highly automated and capital-intensive: annual revenue per employee is close to $1 million.

The enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010 is just beginning to effect the way managed care companies operate. The PPACA calls for health care coverage to be available for all Americans beginning in 2014; the law also eliminates some common exclusions, such as pre-existing conditions. Managed care companies ...