全球医疗保健索赔管理市场 – 行业趋势和 2030 年预测

 医疗保健索赔管理市场分析和规模

人口老龄化是许多国家出现这一现象的主要原因，65 岁以上的人口比例不断增加，慢性病的患病率也随着年龄的增长而上升。此外，医疗保险的经济性也发生了变化。许多国家的人均医疗费用年复合增长率超过 4%。保险计划最初旨在支付重症、急性病或创伤性损伤患者的护理费用，但现在它们更多地涵盖与慢性病相关的可预测风险（和费用）。此外，医疗质量的进步（例如基因疗法等创新疗法）通常会带来更好的结果，但往往会增加医疗成本。

Data Bridge Market Research 分析，医疗保健索赔管理市场在 2022 年为 122.9 亿美元，预计到 2030 年将达到 181.5 亿美元，在 2023 年至 2030 年的预测期内复合年增长率为 5.0%。除了对市场价值、增长率、细分、地理覆盖范围和主要参与者等市场情景的见解外，Data Bridge Market Research 策划的市场报告还包括深度专家分析、患者流行病学、管道分析、定价分析和监管框架。

医疗保健索赔管理市场范围和细分  

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.
• 2021年12月，HealthEdge Software完成了先前宣布的对领先数字健康管理平台well frame Inc的收购。

全球医疗保健索赔管理市场范围

医疗保健索赔管理市场根据类型、组件、交付模式和最终用户进行细分。这些细分市场之间的增长情况将帮助您分析行业中增长缓慢的细分市场，并为用户提供有价值的市场概览和市场洞察，帮助他们做出战略决策，确定核心市场应用。

类型

• 集成解决方案
• 独立解决方案

 成分

• 服务
• 软件

 交付方式

• 现场交付模式
• 基于云的交付模式

最终用户

• 医疗保健付款人
• 医疗保健提供者
• 其他的

医疗保健索赔管理市场区域分析/见解

对医疗保健索赔管理市场进行了分析，并按国家、类型、组成部分、交付方式和最终用户提供了市场规模洞察和趋势。

医疗保健索赔管理市场报告涵盖的国家包括北美洲的美国、加拿大和墨西哥、欧洲的德国、法国、英国、荷兰、瑞士、比利时、俄罗斯、意大利、西班牙、土耳其、欧洲其他地区、亚太地区 (APAC) 的中国、日本、印度、韩国、新加坡、马来西亚、澳大利亚、泰国、印度尼西亚、菲律宾、亚太地区 (APAC) 的其他地区、沙特阿拉伯、阿联酋、南非、埃及、以色列、中东和非洲 (MEA) 的其他地区、南美洲的巴西、阿根廷和南美洲其他地区。

北美占据医疗保健索赔管理市场的主导地位，因为该地区拥有完善的医疗保健基础设施和优惠的报销政策。

由于医疗保健基础设施的不断增长，预计亚太地区将在 2023 年至 2030 年的预测期内以最高的增长率增长。

报告的国家部分还提供了影响单个市场因素和国内市场监管变化，这些因素和变化会影响市场的当前和未来趋势。下游和上游价值链分析、技术趋势和波特五力分析、案例研究等数据点是用于预测单个国家市场情景的一些指标。此外，在提供国家数据的预测分析时，还考虑了全球品牌的存在和可用性以及它们因来自本地和国内品牌的激烈或稀缺竞争而面临的挑战、国内关税和贸易路线的影响。

医疗保健基础设施增长安装基础和新技术渗透

医疗保健索赔管理市场还为您提供详细的市场分析，包括每个国家/地区资本设备医疗保健支出的增长、医疗保健索赔管理市场不同类型产品的安装基数、使用生命线曲线的技术的影响以及医疗保健监管情景的变化及其对医疗保健索赔管理市场的影响。数据涵盖 2011-2021 年的历史时期。

竞争格局和医疗保健索赔管理市场份额分析

医疗保健索赔管理市场竞争格局按竞争对手提供详细信息。详细信息包括公司概况、公司财务状况、产生的收入、市场潜力、研发投资、新市场计划、全球影响力、生产基地和设施、生产能力、公司优势和劣势、产品发布、产品宽度和广度、应用主导地位。以上提供的数据点仅与公司对医疗保健索赔管理市场的关注有关。

医疗保健索赔管理市场的一些主要参与者包括：

• Athenahealth（美国）
• Plexis Healthcare Systems Inc.（美国）
• Cognizant（美国）
• 甲骨文 (美国)
• Allscripts Healthcare LLC（美国）
• nThrive Revenue Systems, LLC（美国）
• eClinicalWorks（美国）
• Context Healthcare Inc.（美国）
• Optum, Inc.（美国）
• Mckesson 公司 (美国)
• DST 系统 (美国)
• Ram Technologies Inc.（美国）
• 通用电气（美国）
• Health Solutions Plus (HSP)（美国）
• Conifer Health Solutions, LLC（美国）
• Quest Diagnostics Incorporated（美国）
• Gebbs Healthcare Solutions（印度）
• SSI Group, LLC（美国）

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