Healthcare Reimbursement Global Market Report 2024

The healthcare reimbursement market size has grown rapidly in recent years. It will grow from $11.33 billion in 2023 to $13.33 billion in 2024 at a compound annual growth rate (CAGR) of 17.7%. The growth observed during the historical period can be attributed to several key factors, including the prevalence of the fee-for-service model, the expansion of health insurance coverage, the involvement of third-party payers, and efforts to contain healthcare costs.

The healthcare reimbursement market size is expected to see rapid growth in the next few years. It will grow to $23.36 billion in 2028 at a compound annual growth rate (CAGR) of 15.0%. The anticipated growth in the forecast period can be primarily attributed to factors such as the transition to value-based care models, the expansion of telehealth services, ongoing healthcare policy and reform efforts, and the adoption of alternative payment models. Notable trends expected to shape this period include developments in telehealth reimbursement, the implementation of alternative payment models (APMs), the influence of the Medicare Access and CHIP Reauthorization Act (MACRA), and the continued use of preauthorization and utilization management practices in healthcare reimbursement.

The escalation in healthcare costs and supportive governmental initiatives stand as primary drivers propelling the growth of the healthcare reimbursement market. As reported by the Journal of the American Medical Association (JAMA), it is anticipated that healthcare expenses in the United States will reach a staggering $6 trillion by 2027, amounting to approximately $17,000 per individual. The Centers for Medicare & Medicaid Services, a key federal agency administering Medicaid, recorded healthcare costs at $4.3 trillion in 2021. The upsurge in healthcare expenses alongside government support encourages more individuals to opt for payer services, thereby contributing significantly to the expansion of the healthcare reimbursement market.

The primary types of healthcare reimbursement claims include underpaid and full paid. Underpaid healthcare reimbursement refers to payments for medical services that are only partially covered or reimbursed by government healthcare programs or insurance providers. Various types of payers participate in this process, including private insurance companies and public healthcare programs. These reimbursements involve multiple service providers such as physician offices, hospitals, diagnostic laboratories, and other medical facilities.

The healthcare reimbursement market research report is one of a series of new reports that provides healthcare reimbursement global market statistics, including healthcare reimbursement industry global market size, regional shares, competitors with a healthcare reimbursement global market share, detailed healthcare reimbursement market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare reimbursement industry. This healthcare reimbursement market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The burgeoning prevalence of chronic diseases plays a pivotal role in steering the healthcare reimbursement market forward. Chronic diseases, such as diabetes, heart disease, cancer, and respiratory disorders, necessitate prolonged medical attention and treatment. Individuals afflicted by chronic conditions often require ongoing medical care involving doctor visits, hospitalizations, medications, and medical procedures. The National Library of Medicine, a U.S. government journal focusing on chronic diseases, predicts a 61.11% increase in the U.S. population aged 50 years and older from 137.25 million in 2020 to 221.13 million in 2050. Moreover, the number of individuals in this age group afflicted with at least one chronic disease is estimated to surge by 99.5%, from 71.522 million in 2020 to 142.66 million by 2050. Consequently, the rising prevalence of chronic diseases worldwide is anticipated to drive the demand for healthcare reimbursement services.

Instances of fraud associated with federal and state government healthcare programs pose a significant impediment to the growth of the healthcare reimbursement market. Fraudulent activities, particularly in medical and Medicare/Medicaid insurance claims, constitute a substantial portion of false claims within the United States. Instances involving unnecessary tests and procedures, falsified billing for services, and manipulation of medical records for fraudulent claims are among the prevalent fraud situations. Notably, the Department of Justice uncovered a substantial healthcare fraud case involving over $800 million in loss and the distribution of millions of opioids in ''pill mill'' clinics across seven federal districts in the Northeastern United States. The surge in healthcare fraud related to government programs results in substantial losses, restraining the growth potential of the healthcare reimbursement market.

Companies within the healthcare reimbursement market are increasingly offering value-based care models, aiming to enhance patient experiences. These models are predicated on the quality of patient care, focusing on healthcare providers' capacity to enhance treatment quality by adhering to specific metrics, including reducing hospital readmissions, improving preventive care, and utilizing certified health technology. Notably, UnitedHealth reported a 29% increase in revenue per consumer served in 2022, driven by the growth in patients served under value-based arrangements, signifying a shift toward improved patient care experiences within the market.

Major corporations within the health reimbursement market are strategically integrating AI into the reimbursement process to augment market revenues. AI's implementation is pivotal in fortifying health reimbursement operations by facilitating predictive fraud detection via comprehensive data analysis and streamlining claims processing to ensure accuracy and efficiency. For example, in August 2023, Codoxo, a leading US-based AI company, launched ClaimPilot, a generative AI product tailored for enhancing healthcare cost containment and payment integrity programs. ClaimPilot is geared towards significantly amplifying operational efficiency while addressing workforce constraints, primarily focusing on automating in-patient and facility claim audits. The innovation aims to exponentially accelerate audit turnaround times and clinician audits per day, removing restrictions imposed by dollar thresholds in claims analysis.

In July 2021, Greenberg Advisors, a US-based strategic M&A services provider, completed the undisclosed acquisition of Medical Reimbursement, a reputable medical billing services provider in the United States. This acquisition serves to bolster the acquirer's capabilities, positioning the company to better cater to the needs of patients within the healthcare sector through enhanced reimbursement services.

Major companies operating in the healthcare reimbursement market include UnitedHealth Group Incorporated, Aviva PLC, Allianz SE, CVS Health Corporation, BNP Paribas Group, Aetna Inc., Nippon Life Insurance Company, WellCare Health Plans Inc., AgileHealthInsurance, Blue Cross Blue Shield Association, Kaiser Foundation Health Plan Inc., Anthem Inc., Centene Corporation, Humana Inc., Health Care Service Corporation, Cigna Corporation, Molina Healthcare Inc., Independence Health Group Inc., Health Net LLC, Universal American Corporation, Blue Shield of California, Tufts Health Plan Inc., Fallon Community Health Plan Inc., CareSource, Health Alliance Plan (HAP), Geisinger Health Plan, SelectHealth

North America was the largest region in the healthcare reimbursement market in 2023. Western Europe was the second largest region in the healthcare reimbursement market. The regions covered in the healthcare reimbursement market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa

The countries covered in the healthcare reimbursement market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Italy, Spain, Canada

The healthcare reimbursement market includes the revenues earned by entities by providing discount from billed charge services, fee-for-service, value based reimbursement services, and bundled payment services. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.


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