Healthcare Reimbursement Market

Global Healthcare Reimbursement Market Size (2024 to 2029)

The global healthcare reimbursement market is estimated to be worth USD 46.16 billion by 2029 from USD 21.38 billion in 2024, growing at a CAGR of 16.64% during the forecast period.

Healthcare reimbursement is the process by which private health insurers or government agencies pay for the services of healthcare providers. Healthcare reimbursement plans are sometimes referred to as healthcare reimbursement arrangements to distinguish them from traditional employer-sponsored health insurance plans. COVID-19 introduces new reimbursement challenges in the healthcare industry, such as billing and coding and patient financial accountability, and this trend will continue to threaten healthcare organizations in 2021. The trend toward digitalization and payment automation was driven by new processes triggered by a significant decrease in face-to-face interaction and a rapid increase in telehealth check-ups. Having the right technologies and best practices in place will significantly aid in ensuring both billing compliance and reimbursement maximization in the future.

MARKET DRIVERS

The growing awareness among people regarding the importance of health insurance policies and healthcare coverage is majorly propelling the global healthcare reimbursement market growth.

A health insurance policy is a contract between an insurance company and a policyholder in which the insurer pays for the life insured's medical expenses. This policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or successor form. This policy applies to all products, all network and non-network physicians, and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.

Growing costs of the federal and state governments' operation of the Medicare and Medicaid programs are expected to accelerate the growth rate of the global healthcare reimbursement market during the forecast period.

Medicaid has become the primary source of medical and health-related services in the United States for low-income and resource-constrained Americans. In 2019, Medicaid accounted for 16% of total healthcare spending in the United States. The federal and state governments play a role in the program's success. Medicaid spending increased in recent years as the percentage of people on Medicaid increased. The Medicare program cost the United States approximately $800 billion in 2019.

Growing primary healthcare worldwide is predicted to promote the global healthcare reimbursement market growth.

According to WHO & PHC, nearly 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget. Achieving the PHC targets will necessitate an additional investment of between $200 and 370 billion USD per year for a more comprehensive package of health services. By 2030, expanding primary health care (PHC) interventions in low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years. PHC is the most inclusive, equitable, cost-effective, and efficient method of improving people's physical and mental health, as well as their social well-being.

Additionally, advancements in EMR technology for monitoring patient responsiveness, rising digital technology advancements in healthcare, growing initiatives from the public and private sectors, and rising healthcare costs are expected to favor the global healthcare reimbursement market. The growing geriatric population worldwide, increasing prevalence of chronic diseases, and rising government investments are further estimated to boost the market growth during the forecast period.

MARKET RESTRAINTS

Deterioration in the quality of care available to patients in need of high-cost treatments, as well as the administrative burden that clinicians frequently face. The high number of incidents involving fraudulent activities for state and government-led health programs is expected to limit the global healthcare reimbursement market growth. Complications exist in the market as a core feature of a complex framework. The risk of patient data breaches or HIPAA violations increases is further expected to limit the market growth.

Impact Of COVID-19 On The Global Healthcare Reimbursement Market

Hospitals and healthcare systems have seen a significant drop in profits and income since the onset of COVID-19. It has been over a year since the COVID-19 pandemic began. While we won't know the full impact on our overall health, economy, and society for many years, we know a lot about how it will affect healthcare systems. Medicare now reimburses hospitals, physicians, pharmacies, and others for administering the COVID-19 vaccine. Healthcare systems responded heroically. Millions of patients were tested, treated, and cured due to their efforts. It went from not having a standard test for COVID-19 to testing over 2 million people in a single day. Unfortunately, many providers and patients postponed or skipped elective procedures and wellness visits. The number of appointments available was limited due to safety protocols, and many people were afraid to go to the doctor.

Evidence of the far-reaching impact of PHC investment constantly grows, especially in times of crisis, such as the COVID-19 pandemic. Another significant change was the replacement of in-person visits with telemedicine visits. While rules and policies were simplified or suspended, documentation and reimbursement remained difficult. The new coding and documentation guidelines added to the pandemic-related denials. As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any fees for vaccine administration. In the long term, the financial impact of COVID-19-related healthcare spending is not expected to have a significant impact on overall healthcare spending. The healthcare systems are expected to work collaboratively to hammer out physician compensation agreements to prepare for future situations like COVID-19.

REPORT COVERAGE

This research report on the global healthcare reimbursement market has been segmented and sub-segmented based on the claims, payer, service provider & region.

Healthcare Reimbursement Market – By Claims

• Underpaid
• Full Paid

Healthcare Reimbursement Market – By Payer

• Private Payers
• Public Payers

Healthcare Reimbursement Market – By Service Provider

• Physician Office
• Hospitals
• Diagnostic Laboratories
• Others

Healthcare Reimbursement Market – By Region

• North America
• Europe
• Asia-Pacific
• Latin America
• The Middle East and Africa

KEY MARKET PARTICIPANTS

Companies such as CVS Health, UnitedHealth Group, Nippon Life Insurance, Allianz, WellCare Health Plans, Aviva Life Insurance Company India Ltd., AgileHealthInsurance, Aetna, Blue Cross Blue Shield Association, Aetna Inc., and Reliance BNP Paribas are currently playing a leading role in the global healthcare reimbursement market.