Healthcare Reimbursement Market Size, Share & Trends Analysis Report By Claim (Underpaid, Full Paid), By Payer (Private Payers, Public Payers), By Service Provider (Hospitals, Physician Office), By Region, And Segment Forecasts, 2024 - 2030

Report Overview

The healthcare reimbursement market size was valued at USD 21.83 billion in 2023 and is projected to grow at a compound annual growth rate (CAGR) of 18.3% from 2024 to 2030. The growth of this market is primarily influenced by factors such as rising costs of healthcare services, in-patient treatments, and medical equipment. The growing demand for insurance-based healthcare reimbursement is driven by the rising adoption of technology tools and innovation in the design and development of reimbursement models. Integration of patient health data, medical records, treatment patterns have also contributed to the growth of this market.

The rise in the prevalence of multiple chronic diseases, the increase in new incidents of trauma injuries and accidents of all sorts, and the growing need for enhanced healthcare infrastructure and services supported by technological advancements and improved resources are playing vital roles in driving the growth of the healthcare reimbursement market. According to the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary National Health Expenditure Projections, healthcare spending share of GDP in the U.S. is expected to reach nearly one fifth of GDP by 2032.

The rapid rate of digital transformation in the healthcare reimbursement industry, the increasing shift from traditional paper-based documentation and processes to computerized, internet connectivity-based advanced systems, and the availability of multiple software solutions and services for streamlining numerous processes in the insurance industry are expected to influence this market during the forecast period.

Emergence and increasing penetration of cloud technology in multiple areas of healthcare reimbursement and insurance industry such as claim application processing, billing, and real-time monitoring and analysis has been helping businesses in addressing issues such as revenue leakage and process administration. Increasing digitization of healthcare industry, emergence of technologies such as telehealth, growing acceptance of virtual care services and remote patients monitoring are also having impact on reimbursement scenario.

Regulations regarding claims and reimbursement, changes in fee-for-service approach, evolving compliance strategies to align with regulations in each country have also influenced growth of this market. As healthcare service, industry increases adoption of innovation and scientifically advanced care alternatives, costs of healthcare services increase at rapid rate. This necessitates the effective healthcare reimbursements for better patient outcomes.

Healthcare insurance and reimbursement benefits provided by the private organizations to its employee, government healthcare assistance programs, and increasing concentration on value-based healthcare delivery is expected to have significant influence on healthcare reimbursement market during forecast period.

Claim Insights

Based on the claims, the underpaid segment dominated the global market and accounted for a revenue share of 81.2% in 2023. Underpaid claims often result from billing and filing errors, contract discrepancies, insurance processing or calculating errors, and more. Patients who fail to provide the necessary documentation and legitimate evidence regarding healthcare services availed under contracts are underpaid in reimbursements. This has led to serious conflicts in the healthcare industry. As a result, out-of-pocket (OOP) healthcare expenditures in the U.S. have increased significantly in the last few decades.  According to the American Health Association, payments for inpatient and outpatient behavioral health services were, on average, 34% & 43 %, respectively, below cost across all payers.

The full paid segment is expected to experience significant CAGR during the forecast period. Growth of this segment is primarily influenced by factors such as increasing adoption of digitization and cloud technology leading to reduced errors, availability of effective claim management systems, and proactive approach of insurance companies to present supportive policy structures. Government support, strict regulations, and framework changes in line with digital claims are expected to assist this growth during the forecast period.

Payer Insights

The public payers dominated the global market for healthcare reimbursements in 2023. This is attributed to rooted trust regarding full payments by public payers in multiple countries, especially in nations with mid or low-income levels, history of full payments, government’s involvement in multiple public insurance businesses and more. Amendments of newly developed policies and acts to ensure growing full payments by insurers also influence the growth of this market. For instance, Affordable Care Act permitted states in the U.S. to expand the coverage for Medicaid, to adults with income levels up to 138 % of the determined poverty levels.[KA4] 

The private payers segment is expected to experience the fastest CAGR of 20.1% during the forecast period. Effective engagement strategies of private businesses, enhanced portfolios offering range of alternatives in insurance, and presence of skilled professionals working in industry are influencing this segment. Growing competition in the private insurance market and technology innovation adopted by multiple companies for comprehensive coverage and quick claim settlements through digitized platforms are expected to fuel growth of this segment during forecast period.

Service Provider Insights

Based on service providers, the hospital segment held the largest revenue share of the market in 2023. This is attributed to increased hospital admissions due to the growing prevalence of chronic diseases, enhanced hospital infrastructures in multiple countries with growing economies, a rising number of specialty hospitals, and more. Costs associated with hospitals equipped with advanced healthcare technologies, such as emergency care services, inpatient care, specialized surgeries, and others, necessitate reimbursements.

The physician office segment is expected to witness the fastest CAGR from 2024 to 2030. This segment is primarily influenced by an inclination towards outpatient care and ambulatory services and growing preferences for avoiding hospital admissions as long as possible. The higher costs associated with in-patient treatments and specialty hospital admissions encourage individuals and patients to avail of healthcare services from physician’s offices. In addition, the availability of personalized services and value-based care approaches are also attracting many patients for this segment. The availability of affordable diagnostic technologies and the inclination towards early diagnosis and treatments are expected to develop a growing demand for this market in the approaching years.

Regional Insights

North America dominated the global market of healthcare reimbursement and accounted for a revenue share of 53.2 % in 2023. The region's positive regulatory scenario regarding reimbursements and healthcare insurance primarily drives this market. The presence of multiple public payers also influences its growth. In addition, government support and encouragement for ensuring a rise in healthcare-insured individuals contribute to the development.

U.S. Healthcare Reimbursement Market Trends

The U.S. healthcare reimbursement market dominated the regional industry in 2023. This is attributed to multiple factors, such as rising healthcare costs, the high prevalence of chronic diseases such as cancer and cardiovascular diseases, and the increase in technological innovations adopted by the key companies in the market. According to the National Cancer Institute at the National Institutes of Health, 2,001,140 new cancer cases in the U.S. were estimated to be diagnosed in 2023.

Europe Healthcare ReimbursementMarket Trends

Europe was identified as a lucrative region in 2023. This market is mainly influenced by factors such as large geriatric population, rising prevalence of chronic diseases such as diabetes, respiratory diseases and others, effective penetration of public healthcare assistance and funding, and more.

Germany healthcare reimbursement market held the significant revenue share in 2023. Presence of robust healthcare system in the country, regulations such as mandating health insurance for all residents, and rising healthcare innovations in the industry are expected to assist growth for this market in approaching years.

Latin America Healthcare Reimbursement Market Trends

Latin America healthcare reimbursement market is expected to experience the fastest CAGR of 19.7% from 2024 to 2030. This is attributed to the rise in healthcare expenditures and increased costs associated with healthcare services, advancements and adoption of technologies such as Health Technology Assessment (HTA), and growing focus on ensuring enhanced availability of healthcare insurance by public and private sector companies in the region.

Key Companies & Market Share Insights

Some of the key companies in the healthcare reimbursement market include United HealthCare Services, Inc., Allianz Care, CVS Health, Reliance Nippon Life Insurance Company Limited, and others. To address the growing competition, major companies in the market are adopting strategies such as streamlining reimbursement processes through technology adoption, increasing focus on collaborations with hospitals and organizations, and more.

• CVS Health, one of the prominent healthcare services organizations, provides multiple offerings, including commercial health coverage, condition management, health and wellness products, mental health services, and others. It also offers prescription drug coverage and pharmacy services.

• United HealthCare Services, Inc., a major health insurance and services organization in the U.S., offers a range of services, including Medicare, individual & family plans for short terms, self-employed plans, student plans, all supplement plans, dental plans, vision plans, and others.

Recent Developments

• In September 2024, Cigna Healthcare introduced E-Treatment option through MDLIVE (Evernorth). This has made MDLIVE virtual care available for individuals who have Cigna Healthcare insurance derived from the Affordable Care Act. 

Healthcare Reimbursement Market Report Scope

Global Healthcare Reimbursement Market Report Segmentation

This report forecasts revenue growth at global, regional, and country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2030. For this study, Grand View Research has segmented the global healthcare reimbursement market report based on claim, Payer, service provider and region.

• Claim Outlook (Revenue, USD Million, 2018 - 2030)

  • Underpaid

  • Full Paid

• Payer Outlook (Revenue, USD Million, 2018 - 2030)

  • Private Payers

  • Public Payers

• Service Provider Outlook (Revenue, USD Million, 2018 - 2030)

  • Hospitals

  • Physician Office

  • Diagnostic Laboratories

  • Others

• Regional Outlook (Revenue, USD Million, 2018 - 2030)

  • North America

    • U.S.

    • Canada

    • Mexico

  • Europe

    • UK

    • Germany

    • France

    • Italy

    • Spain

    • Denmark

    • Sweden

    • Norway

  • Asia Pacific

    • Japan

    • China

    • India

    • Australia

    • South Korea

    • Thailand

  • Latin America

    • Brazil

    • Argentina

  • Middle East and Africa (MEA)

    • South Africa

    • Saudi Arabia

    • UAE

    • Kuwait