世界のヘルスケア請求管理市場 – 業界動向と2030年までの予測

 ヘルスケア請求管理市場の分析と規模

多くの国では人口の高齢化が主な原因であり、65歳以上の人口の割合が増加し、加齢とともに慢性疾患の罹患率が上昇しています。さらに、健康保険の経済状況も変化しています。多くの国では、一人当たりの医療費の平均が年平均4%以上の成長率で増加しています。保険プランは当初、重篤な急性疾患や外傷を患う患者の治療費をカバーするように設計されていましたが、現在では慢性疾患に伴う予測可能なリスク（および費用）をカバーすることが多くなっています。さらに、医療の質の向上（遺伝子治療などの革新的な治療法など）により、結果が向上することがよくありますが、医療費が上昇することもよくあります。

Data Bridge Market Research の分析によると、2022 年に 122.9 億米ドルであった医療保険請求管理市場は、2023 年から 2030 年の予測期間中に 5.0% の CAGR で成長し、2030 年には 181.5 億米ドルに達すると予想されています。市場価値、成長率、セグメンテーション、地理的範囲、主要プレーヤーなどの市場シナリオに関する洞察に加えて、Data Bridge Market Research がまとめた市場レポートには、詳細な専門家の分析、患者の疫学、パイプライン分析、価格分析、規制の枠組みも含まれています。

ヘルスケア請求管理市場の範囲とセグメンテーション  

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

ヘルスケア請求管理市場では、各国の医療設備支出の増加、ヘルスケア請求管理市場向けのさまざまな種類の製品のインストールベース、ライフライン曲線を使用したテクノロジーの影響、ヘルスケア規制シナリオの変更とそれらがヘルスケア請求管理市場に与える影響など、詳細な市場分析も提供されます。データは、2011年から2021年までの履歴期間で利用できます。

競争環境と医療保険請求管理の市場シェア分析

ヘルスケア請求管理市場の競争状況は、競合他社ごとに詳細を提供します。含まれる詳細には、会社概要、会社の財務状況、収益、市場の可能性、研究開発への投資、新しい市場への取り組み、世界的なプレゼンス、生産拠点と施設、生産能力、会社の強みと弱み、製品の発売、製品の幅と広さ、アプリケーションの優位性などがあります。提供されている上記のデータ ポイントは、ヘルスケア請求管理市場に関連する会社の焦点にのみ関連しています。

医療保険請求管理市場で活動している主要企業は次のとおりです。

• アテナヘルス（米国）
• プレクシス ヘルスケア システムズ (米国)
• コグニザント（米国）
• オラクル（米国）
• オールスクリプツヘルスケアLLC（米国）
• nThrive Revenue Systems, LLC (米国)
• eClinicalWorks（米国）
• コンテキストヘルスケア株式会社（米国）
• オプタム社（米国）
• マッケソンコーポレーション（米国）
• DST システムズ (米国)
• ラムテクノロジーズ社（米国）
• ゼネラル・エレクトリック（米国）
• ヘルスソリューションズプラス（HSP）（米国）
• コニファーヘルスソリューションズ LLC (米国)
• クエスト・ダイアグノスティクス・インコーポレーテッド（米国）
• ゲッブス ヘルスケア ソリューションズ (インド)
• SSIグループLLC（米国）

SKU-56615