Major players in the healthcare reimbursement market are UnitedHealth Group, Aviva, Allianz, CVS Health, BNP Paribas, Aetna, Nippon Life Insurance, WellCare Health Plans, AgileHealthInsurance, and Blue Cross Blue Shield Association.
The global healthcare reimbursement market is expected to decline from $15.19 billion in 2020 to $12.98 billion in 2021 at a compound annual growth rate (CAGR) of -14.5%. The decline is due to economic slowdown across countries owing to the COVID-19 outbreak and the measures to contain it. The market is expected to reach $23.02 billion in 2025 at a CAGR of 15%.
The healthcare reimbursement market consists of sales of healthcare reimbursement services by entities (organizations, sole traders and partnerships) that provide healthcare reimbursement services, which include the payment that hospitals, diagnostic facilities, doctors, or other health care providers receive for providing medical service to people.The healthcare reimbursement for a person’s health care expenses is mostly covered partially or fully by the government or a health insurer.
Only goods and services traded between entities or sold to end consumers are included.
The healthcare reimbursement market covered in this report is segmented by claims into underpaid, full paid. It is also segmented by payers into private payers, public payers,; service provider into physician office, hospitals, diagnostic laboratories, others.
The regions covered in this report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.
Several incidences of fraud related to federal and state government health care programs hamper the growth of the healthcare reimbursement market.The medical insurance fraud and Medicare/Medicaid insurance fraud make up the majority of false claims in the USA.
The National Health Care Anti-Fraud Association (NHCAA) reveals that unnecessary and duplicate tests and procedures, hacking into a patient’s medical records to submit false claims, billing services never rendered, falsifying diagnosis are some common situations that occur. According to the Department of Justice, one of the largest health care fraud enforcement actions across seven federal districts in the Northeastern United States, involved more than $800 million in loss and the distribution of over 3.25 million pills of opioids in ""pill mill"" clinics. The rise in healthcare fraud related to federal and state government programs create huge loss for the business restraining the growth of the healthcare reimbursement market.
In March 2019, Centern Corporation, a large publicly-traded company and a multi-line managed care enterprise, acquired WellCare for $17.3 billion. The transaction will result in the establishment of a premier organization providing government-sponsored healthcare programs along with having expertise in Medicaid, Medicare, and Health insurance marketplace. WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage, and Medicare prescription drug plans for more than 6.3 million members across the country.
The increasing cost of healthcare and supportive government programs are the key factors that are driving the healthcare reimbursement market growth.According to the Journal of the American Medical Association (JAMA), US healthcare costs are expected to reach $6 trillion, which is $17,000 per person by 2027.
In 2019, the US healthcare policy announced plans to expand healthcare insurance coverage and make changes to accountable care organizations. The rising healthcare cost and supportive government policies increase the number of people opting for payer services and thereby contributes to the growth of healthcare reimbursement market.
Companies in the healthcare reimbursement market are providing options of value-based care models to cater better experience for the patients.Value-based care models are based on the quality of patient’s treatment and how well healthcare providers can improve their quality by adhering to certain metrics such as reducing hospital readmissions, improving preventative care, and using particular kinds of certified health technology and help lower healthcare costs.
For instance, UnitedHealth estimated that its payments to healthcare providers based on value-based care relationships will be $75 billion by 2020.
The countries covered in the market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.
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