Mercado global de gestión de reclamaciones de atención médica: tendencias de la industria y pronóstico hasta 2030

 Análisis y tamaño del mercado de gestión de reclamaciones de atención médica

El envejecimiento de la población es una de las principales causas de este fenómeno en muchos países: una proporción cada vez mayor de la población tiene más de 65 años y la prevalencia de enfermedades crónicas aumenta a medida que la gente envejece. Además, la economía de los seguros de salud ha cambiado. El coste medio per cápita de la atención sanitaria en muchos países aumentó a una tasa anual compuesta de más del 4%. Los planes de seguros se diseñaron inicialmente para cubrir el coste de la atención de pacientes con enfermedades graves y agudas o lesiones traumáticas, pero ahora cubren con mayor frecuencia los riesgos (y costes) previsibles asociados a las enfermedades crónicas. Además, los avances en la calidad de la atención sanitaria (por ejemplo, tratamientos innovadores como la terapia génica) suelen dar mejores resultados, pero a menudo aumentan los costes de la atención sanitaria.

Data Bridge Market Research analiza que se espera que el mercado de gestión de reclamaciones de atención médica, que fue de USD 12,29 mil millones en 2022, alcance los USD 18,15 mil millones para 2030, a una CAGR del 5,0% durante el período de pronóstico de 2023 a 2030. Además de los conocimientos sobre escenarios de mercado como el valor de mercado, la tasa de crecimiento, la segmentación, la cobertura geográfica y los principales actores, los informes de mercado seleccionados por Data Bridge Market Research también incluyen un análisis profundo de expertos, epidemiología del paciente, análisis de la cartera, análisis de precios y marco regulatorio.

Alcance y segmentación del mercado de gestión de reclamaciones de atención médica  

Market Definition

Healthcare claims management is a process that includes tasks like organizing, billing, filling, updating, and processing medical claims related to patients' diagnoses, treatment, and medication. In other words, it is software that manages medical claims and reimbursement processes that is increasingly allowing healthcare providers to maximize their revenues through proper claim management. It is a two-way street between patients, healthcare providers, billing companies, and insurance providers.

Global Healthcare Claims Management Market Dynamics

Drivers

• Growing concerns about data privacy

Despite the market's expected growth, there are growing concerns about data privacy. As technology advances, modern technologies such as cloud, mobile, and next-generation databases are increasingly used to manage, store, and retrieve such claims data. These factors have combined to make healthcare data security a persistent concern for the entire healthcare industry. Rules and regulations governing healthcare data are constantly evolving to ensure patients have the data protection they require and deserve. These are certain factors that boost the growth of the market.

• Digitization of software

Healthcare providers and medical offices adopted digitization at a rapid rate. A lot of information about the patients who receive services each day is being gathered. An adequate system is required for health services to organize, manage, and carry out plans efficiently. The ‘Administrative Errors: Technical Series on Safer Primary Care 2016’ report published by the World Health Organization (WHO) estimated that about 5–50% of medical errors in primary care are administrative errors, further prompting the need for digitization. As a result, there is a growing need for medical billing software.

Opportunities

• Rising duplicate insurance claims

The use of software facilitates communication across various domains and subdomains of hospitals. The programme uses cutting-edge approaches to ensure seamless interoperability between insurance companies and hospitals while managing patient data and information about their treatment. The identical claims and a lack of transparency, the insurance firms reportedly reject about one out of every five claims. Thus, the use of advanced methodologies and interoperability between these domains of hospitals will aid in reducing the number of fraudulent claims, further boosting the market growth.

Restraints/Challenges

• Threat of cyber crimes

Concerns over the privacy of the patient's medical history and other personal information have grown as a result of the rise in cybercrime over the past few years. The Indiana Attorney General reported in 2015 that a cyberattack on the Indiana-based company Medical Informatics Engineering compromised the data of more than four million patients from 230 institutions (MIE). Malware, phishing, Man in the Middle attacks, Trojans, and other rising cyber threats are among those limiting market expansion to some extent.

This healthcare claims management market report provides details of new recent developments, trade regulations, import-export analysis, production analysis, value chain optimization, market share, impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on the healthcare claims management market contact Data Bridge Market Research for an Analyst Brief, our team will help you take an informed market decision to achieve market growth.

COVID-19 Impact on the Healthcare Claims Management Market

The pandemic of COVID-19 is expected to have a significant impact on market growth. Since the beginning of the pandemic, there has been tremendous pressure on claim management software developers and providers due to the large number of people becoming infected and then being admitted to hospitals. Claim denials have also increased as a result of the COVID-19 pandemic. COVID-19 had a positive impact on the market. During the COVID-19 pandemic, the general impairment of health for those with SARS-CoV-2 infection lead to increase in claim management solutions, as physiological impact of the pandemic increases the claims related to the healthcare.

Recent developments

• In February 2022, Health Edge and Citius Tech formed a strategic partnership to provide joint go-to-market implementation and consultation services for HealthEdge solutions in Core administration, care management, and payment integrity to health plans pursuing value-based care and streamlined operations.
• In December 2021, HealthEdge Software completed its previously announced acquisition of well frame Inc, a leading digital health management platform.

Global Healthcare Claims Management Market Scope

The healthcare claims management market is segmented on the basis of type, component, delivery mode and end user. The growth amongst these segments will help you analyze meagre growth segments in the industries and provide the users with a valuable market overview and market insights to help them make strategic decisions for identifying core market applications.

Type

• Integrated Solutions
• Standalone Solutions

 Component

• Services
• Software

 Delivery Mode

• On-Premise Delivery Mode
• Cloud-Based Delivery Mode

End User

• Healthcare Payers
• Healthcare Providers
• Others

Healthcare Claims Management Market Regional Analysis/Insights

The healthcare claims management market is analyzed and market size insights and trends are provided by country, type, component, delivery mode and end user as referenced above.

The countries covered in the healthcare claims management market report are U.S., Canada and Mexico in North America, Germany, France, U.K., Netherlands, Switzerland, Belgium, Russia, Italy, Spain, Turkey, Rest of Europe in Europe, China, Japan, India, South Korea, Singapore, Malaysia, Australia, Thailand, Indonesia, Philippines, Rest of Asia-Pacific (APAC) in the Asia-Pacific (APAC), Saudi Arabia, U.A.E, South Africa, Egypt, Israel, Rest of Middle East and Africa (MEA) as a part of Middle East and Africa (MEA), Brazil, Argentina and Rest of South America as part of South America.

North America dominates the healthcare claims management market because of the presence of well-developed healthcare infrastructure and favourable reimbursement policies in the region.

Asia-Pacific is expected to grow at the highest growth rate in the forecast period of 2023 to 2030 owing to the growing healthcare infrastructure.

The country section of the report also provides individual market impacting factors and changes in regulation in the market domestically that impacts the current and future trends of the market. Data points like down-stream and upstream value chain analysis, technical trends and porter's five forces analysis, case studies are some of the pointers used to forecast the market scenario for individual countries. Also, the presence and availability of global brands and their challenges faced due to large or scarce competition from local and domestic brands, impact of domestic tariffs and trade routes are considered while providing forecast analysis of the country data.

Healthcare Infrastructure Growth Installed base and New Technology Penetration

El mercado de gestión de reclamaciones de atención médica también le proporciona un análisis detallado del mercado para cada país: crecimiento del gasto en atención médica para equipos de capital, base instalada de diferentes tipos de productos para el mercado de gestión de reclamaciones de atención médica, impacto de la tecnología mediante curvas de línea de vida y cambios en los escenarios regulatorios de atención médica y su impacto en el mercado de gestión de reclamaciones de atención médica. Los datos están disponibles para el período histórico 2011-2021.

Análisis del panorama competitivo y de la cuota de mercado de la gestión de reclamaciones sanitarias

El panorama competitivo del mercado de gestión de reclamaciones de atención médica proporciona detalles por competidor. Los detalles incluidos son una descripción general de la empresa, las finanzas de la empresa, los ingresos generados, el potencial de mercado, la inversión en investigación y desarrollo, las nuevas iniciativas de mercado, la presencia global, los sitios e instalaciones de producción, las capacidades de producción, las fortalezas y debilidades de la empresa, el lanzamiento de productos, la amplitud y variedad de productos, el dominio de las aplicaciones. Los puntos de datos anteriores proporcionados solo están relacionados con el enfoque de las empresas en relación con el mercado de gestión de reclamaciones de atención médica.

Algunos de los principales actores que operan en el mercado de gestión de reclamaciones de atención médica son:

• Athenahealth (Estados Unidos)
• Plexis Healthcare Systems Inc. (Estados Unidos)
• Cognizant (Estados Unidos)
• Oracle (Estados Unidos)
• Allscripts Healthcare LLC (Estados Unidos)
• nThrive Revenue Systems, LLC (Estados Unidos)
• eClinicalWorks (Estados Unidos)
• Context Healthcare Inc. (Estados Unidos)
• Optum, Inc. (Estados Unidos)
• Corporación Mckesson (Estados Unidos)
• Sistemas DST (EE.UU.)
• Ram Technologies Inc. (Estados Unidos)
• General Electric (Estados Unidos)
• Soluciones de salud Plus (HSP) (Estados Unidos)
• Conifer Health Solutions, LLC (Estados Unidos)
• Quest Diagnostics Incorporated (Estados Unidos)
• Soluciones sanitarias de Gebbs (India)
• El Grupo SSI, LLC (EE. UU.)

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