Global Healthcare Reimbursement Market by Payers (Private, Public), by Claim (Underpaid, Fully Paid), by Service Provider (Hospitals, Diagnostic Labs) and Region (North America, Latin America, Europe, Asia Pacific and Middle East & Africa), Forecast To 2028

Summary of the Report

In 2017, the global healthcare reimbursement market was valued at USD 3.59 trillion. The primary growth factors for the market have been the growing healthcare burden in both developed and developing countries, as well as favorable regulatory policies and supportive reimbursement scenarios.

The healthcare costs in the United States have increased relative to the average annual income of citizens. In 2016, the healthcare costs amounted to USD 3.3 trillion, which is 17.9% of the gross national product. It accounted for 6.0% of total income in 2013. It accounted for 6.0% of the overall income in 2013. The U.S. economic crisis has increased healthcare costs, both for individuals and businesses. In two years, the Obamacare Act led to a 12.0% decrease in out-of-pocket healthcare spending.

The market is expected to grow as a result of rising patient volumes and increased prescription drug costs. Stakeholders are interested in reimbursement due to the persistent rise in healthcare costs. The cost of prescription drugs, doctor consultations, and treatment is on the rise, which means that healthcare spending is rising.

Changes in lifestyles have led to an increase in chronic diseases like diabetes and heart disease, which is driving up healthcare costs. Nearly half of Americans have one or more of these conditions, which can be costly to treat. Modern medicine has made it possible for people to live longer and lower their healthcare costs.

The market has seen a variety of initiatives, both public and private, play a crucial role in its development. The Affordable Care Act (ACA), which was implemented in the U.S.A, focuses on increasing health insurance coverage for individuals with low income. This law encourages innovative ways to provide medical care that reduces health care costs. It also makes affordable health insurance more accessible to more people.

The shifting payment model encourages healthcare providers to create accountable care organizations (ACOs), which coordinate care between primary care physicians, hospitals and pharmacists. This helps to reduce costs while improving quality.

Claim Insights

Due to an increasing number of false claims, and the unnecessary use of healthcare services, the underpaid segment accounted the largest portion of the global market. This has resulted in underpaid settlements. Individuals and businesses can defraud the federal and state governments' health care programs in many ways. It includes filing a claim for services, pharmaceutical, or healthcare treatment that was never provided. The False Claim Act was created to control frauds.

Individuals are more likely to use services if they don't have to pay the full cost. Some people will use healthcare services they don't need. Some people visit a doctor or walk-in clinic to enjoy the social benefit of human companionship, rather than to meet a medical need.

Payers Insights

In 2017, the market was dominated by private payers. Because of the large number private players in the market, they are expected to continue to dominate the market through the forecast period. In the U.S., there are more than 125 private insurance companies that offer private health coverage.

Since 2014, the Affordable Care Act, also known as the Patient Protection and Affordable Care Act (PPACA), has been in effect in the United States. The Affordable Care Act and Patient Protection and Affordable Care Act (PPACA), are health care reform laws that aim to improve the accessibility, affordability, and use of insurance. The Affordable Care Act includes several provisions that expand the private insurance market. This law encourages employers to offer health insurance. It also requires that people who are not covered by the government or their employer's insurance plan purchase private insurance. This is a contributing factor to the growth of this segment.

Service Provider Insights

In 2017, hospitals were the top service provider in the healthcare reimbursement market. This is due to the growing geriatric population and increasing number of surgeries. The ability to combine hospital systems in a large area or population increases the bargaining power and allows for higher reimbursement.

Hospitals in North America are paid according to their diagnosis-related group (DRG). This is a fixed amount for each hospital stay. If a hospital treats a patient for less than DRG payment, it makes a profit. Hospitals that spend more than DRG to treat patients lose money.

The forecast period will see significant growth in physician offices due to the growing patient base and government reforms that encourage advanced healthcare infrastructure. Providers who are enrolled in multiple insurance plans have access to a wide range of patients and can take advantage of low-cost healthcare coverage through the ACA.

Regional Insights

In 2017, North America was the dominant market. It will continue to dominate the market for the duration of the forecast period. The market's growth is aided by a strong reimbursement system and the presence of many insurance players. The Affordable Care Act makes it mandatory for all Americans to have coverage. Federal authorities penalized those states that didn't comply. It acts as a driver for the regional market.

In terms of market share, Europe was second to North America. The market is driven by a growing geriatric population, as well as chronic diseases such atherosclerosis, cardiovascular disease, respiratory disease, and respiratory diseases. The Western European healthcare system has been moving rapidly to adopt performance-based reimbursement over the past decade.

Asia Pacific will experience the fastest growth during the forecast period. Market growth will be boosted by the expected rise in geriatric populations and supportive government initiatives in developing countries. Market growth is also supported by the high level of private and public healthcare spending, as well as high economic development and penetration of insurance services in urban and rural areas.

Healthcare Reimbursement Market Share Insights

This market is extremely competitive. Key participants include UnitedHealth Group, Aviva, Allianz, CVS Health, BNP Paribas, Aetna, Nippon Life Insurance, WellCare Health Plans, AgileHealthInsurance, and The Blue Cross Blue Shield Association.In an attempt to retain share, diversify product portfolio, and expand geographic presence, market players are frequently undertaking mergers & acquisitions as their primary strategy.

Healthcare Reimbursement Market Report Scope

The Report Covers Certain Segments

This report forecasts revenue growth at the global, regional and country levels. It also provides analysis on industry trends in each sub-segment from 2014 through 2026. Grand View Research has divided the global healthcare reimbursement market report based on claim, payers and service provider.

• Claim Outlook (Revenue, USD Billion, 2014 - 2026)

  • Unterpaid

  • Fully Paid

• Payers Outlook (Revenue, USD Billion, 2014 - 2026)

  • Private Payers

  • Public Payers

• Service Provider Outlook (USD Billion, 2014 - 2026)

  • Doctor office

  • Hospitals

  • Diagnostic Laboratories

  • Other

• Regional Outlook (USD Billion 2014-2026)

  • North America

    • U.S.

    • Canada

  • Europe

    • U.K.

    • Germany

  • Asia Pacific

    • Japan

    • China

  • Latin America

    • Brazil

    • Mexico

  • Middle East & Africa

    • South Africa

    • Saudi Arabia

These are the most frequently asked questions about this report

b. Global healthcare reimbursement market size was USD 6.1 trillion in 2019, and is projected to rise to USD 7.2 trillion by 2020.

b. Global healthcare reimbursement market will grow at a compound annual rate of 19.0% between 2018 and 2026, to reach USD 20.5 trillion in 2026.

b. With a market share of 59.0%, North America was the leader in healthcare reimbursement markets in 2019, This can be attributed to the strong reimbursement system and large number of players in insurance.

b. Some key players operating in the healthcare reimbursement market include UnitedHealth Group, Aviva, Allianz, CVS Health, BNP Paribas, Aetna, Nippon Life Insurance, WellCare Health Plans, AgileHealthInsurance, and The Blue Cross Blue Shield Association.

b. The market's growth is being driven by the rising cost of healthcare and support programs from the government.

Up Market Research published a new report titled “Healthcare Reimbursement Market research report which is segmented by Payers (Private, Public), by Claim (Underpaid, Fully Paid), by Service Provider (Hospitals, Diagnostic Labs), By Players/Companies BNP Paribas, The Blue Cross Blue Shield Association, CVS Health, Nippon Life Insurance, Aviva, Aetna, UnitedHealth Group, WellCare Health Plans, AgileHealthInsurance, Allianz”. As per the study the market is expected to grow at a CAGR of XX% in the forecast period.

The report covers comprehensive data on emerging trends, market drivers, growth opportunities, and restraints that can change the market dynamics of the industry. It provides an in-depth analysis of the market segments which include products, applications, and competitor analysis.

Global Healthcare Reimbursement Market Report Segments:

The market is segmented by Payers (Private, Public), by Claim (Underpaid, Fully Paid), by Service Provider (Hospitals, Diagnostic Labs).

Healthcare Reimbursement Market research report delivers a close watch on leading competitors with strategic analysis, micro and macro market trend and scenarios, pricing analysis and a holistic overview of the market situations in the forecast period. It is a professional and a detailed report focusing on primary and secondary drivers, market share, leading segments and geographical analysis. Further, key players, major collaborations, merger & acquisitions along with trending innovation and business policies are reviewed in the report.

Key Benefits for Industry Participants & Stakeholders:

• Industry drivers, restraints, and opportunities covered in the study
• Neutral perspective on the market performance
• Recent industry trends and developments
• Competitive landscape & strategies of key players
• Potential & niche segments and regions exhibiting promising growth covered
• Historical, current, and projected market size, in terms of value
• In-depth analysis of the Healthcare Reimbursement Market

Overview of the regional outlook of the Healthcare Reimbursement Market:

Based on region, the market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa (MEA). North America region is further bifurcated into countries such as U.S., and Canada. The Europe region is further categorized into U.K., France, Germany, Italy, Spain, Russia, and Rest of Europe. Asia Pacific is further segmented into China, Japan, South Korea, India, Australia, South East Asia, and Rest of Asia Pacific. Latin America region is further segmented into Brazil, Mexico, and Rest of Latin America, and the MEA region is further divided into GCC, Turkey, South Africa, and Rest of MEA.

Highlights of The Healthcare Reimbursement Market Report:

1. The market structure and projections for the coming years.
2. Drivers, restraints, opportunities, and current trends of Healthcare Reimbursement Market.
3. Historical data and forecast.
4. Estimations for the forecast period 2028.
5. Developments and trends in the market.

                1. Private

                2. Public

                1. Underpaid

                2. Fully Paid

                1. Hospitals

                2. Diagnostic Labs

9. Market scenario by region, sub-region, and country.
10. Market share of the market players, company profiles, product specifications, SWOT analysis, and competitive landscape.
11. Analysis regarding upstream raw materials, downstream demand, and current market dynamics.
12. Government Policies, Macro & Micro economic factors are also included in the report.

We have studied the Healthcare Reimbursement Market in 360 degrees via. both primary & secondary research methodologies. This helped us in building an understanding of the current market dynamics, supply-demand gap, pricing trends, product preferences, consumer patterns & so on. The findings were further validated through primary research with industry experts & opinion leaders across countries. The data is further compiled & validated through various market estimation & data validation methodologies. Further, we also have our in-house data forecasting model to predict market growth up to 2028.

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Reasons to Purchase the Healthcare Reimbursement Market Report:

• The report includes a plethora of information such as market dynamics scenario and opportunities during the forecast period
• Segments and sub-segments include quantitative, qualitative, value (USD Million,) and volume (Units Million) data.
• Regional, sub-regional, and country level data includes the demand and supply forces along with their influence on the market.
• The competitive landscape comprises share of key players, new developments, and strategies in the last three years.
• Comprehensive companies offering products, relevant financial information, recent developments, SWOT analysis, and strategies by these players.