Healthcare Reimbursement Market Report 2025

This Healthcare Reimbursement market report provides a comprehensive analysis of the market’s characteristics, size, and growth, including segmentation, regional and country-level breakdowns, competitive landscape, market shares, trends, and strategies. It also tracks historical and forecasted market growth across various geographies.

The healthcare reimbursement market size has grown rapidly in recent years. It will grow from $13.41 billion in 2024 to $15.73 billion in 2025 at a compound annual growth rate (CAGR) of 17.3%. The growth in the historic period can be attributed to fee-for-service model, health insurance expansion, third-party payers, cost containment efforts.

The healthcare reimbursement market size is expected to see rapid growth in the next few years. It will grow to $26.71 billion in 2029 at a compound annual growth rate (CAGR) of 14.2%. The growth in the forecast period can be attributed to value-based care, telehealth expansion, healthcare policy and reform, alternative payment models. Major trends in the forecast period include telehealth reimbursement, alternative payment models (apms), medicare access and chip reauthorization act (macra), preauthorization and utilization management.

The rising cost of healthcare and supportive government programs are key drivers of growth in the healthcare reimbursement market. According to the Journal of the American Medical Association (JAMA), healthcare costs in the United States are projected to reach $6 trillion, or $17,000 per person, by 2027. These escalating costs, coupled with favorable government policies, are increasing the adoption of payer services, thereby fueling the expansion of the healthcare reimbursement market.

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. For instance, in May 2024, the Statens Serum Institut, a Denmark-based governmental research institution, reported an increase in invasive pneumococcal disease cases from 553 in 2022 to 622 in 2023, highlighting a growing incidence. Similarly, in August 2024, the Australian Bureau of Statistics, an Australia-based government agency, reported that influenza cases rose from 426 in 2022 to 598 in 2023, accompanied by an increase in influenza-associated deaths during the same period. This rising prevalence of chronic diseases globally is expected to drive the demand for 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 2024, Vālenz Health, a US-based healthcare technology company, acquired Bluebook™ for an undisclosed amount. This acquisition aligns with Vālenz Health's mission to enhance healthcare transparency and efficiency by providing technology solutions that manage costs and improve patient outcomes. Bluebook™, a US-based healthcare technology company, specializes in pricing transparency and cost management solutions.

Healthcare reimbursement is the payment process through which hospitals, doctors, and other healthcare providers are compensated for delivering medical services to patients. This payment is typically made by health insurance companies, government programs, or directly by patients, depending on their coverage. Reimbursement includes costs associated with treatments, procedures, tests, and medications, ensuring providers are fairly compensated and patients can access essential care without bearing the full cost upfront.

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.

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 2024. 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, Canada, Italy, Spain.

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.

This product will be delivered within 3-5 business days.