What? When? Why?

What is the size of the global healthcare claims management market?

The global healthcare claims management market is forecasted to grow to USD 15.82 billion by 2027.

What is healthcare claims management?

Healthcare claim management refers to the software and systems to manage patient claims. Claim management provides organizing, billing, filling, updating, and processing of the patient's health insurance claims for all kinds of healthcare services like medication, admission to hospitals, operations, etc. Healthcare claim management helps reduce the number of claim declines for the patients and optimizes the process of claiming through proper patient medical history and eligibility calculations. The healthcare claim management systems make it easier for healthcare professionals to process billing without errors, declines, and rebilling, making the patient's experience more pleasant. 

How does COVID-19 impact the dynamics of the global healthcare claims management market?

The COVID-19 pandemic has caused difficult times in many different parts of the world. Due to the restrictions on production and supply of commodities, all firms faced losses due to the strict quarantines and lockdowns. As a result, access to even essentials of daily living became quite challenging. The epidemic also significantly impacted the healthcare sector, and hospitals completely turned their focus to providing care for COVID-19 patients. The other healthcare department activities were consequently frequently put off.

However, the pandemic had a good effect on the market for healthcare claim management options. Medical costs were soaring, making it difficult for many patients to pay them. More patients were hospitalized and placed in intensive care units with 24/7 hospital services, oxygen cylinders, and ventilators. As healthcare costs rose, so did the demand for proper claim management, which helped the market expand. Additionally, claim management technologies enabled quicker, more streamlined data transfers, which helped with the situation. The psychological effects of the pandemic also led to people claiming reimbursements, further promoting the market. 

Therefore, the pandemic positively impacted the global healthcare claims management market.

What are the factors driving the healthcare claims management market?

Y-O-Y growth of the aging population and the number of chronic diseases worldwide are leading to more hospital admissions and high healthcare costs. The claim management system helps reduce the burning costs of healthcare and provides quality care for affordable capacities. In addition, the rising medical insurance coverages within populations and the increased awareness about the benefits of healthcare claims management are expected to support healthcare claims management market growth. Additionally, technological advancements and government initiatives like improved insurance and reimbursement plans and funding systems are promoting market growth. 

The benefits of healthcare claim management and increasing efficiency to promote market growth

As healthcare systems adopt IT innovations, the claim management system is an excellent support for the initiative. The healthcare claim management systems help increase patient satisfaction and reduce complaints at the healthcare centers, thus initiating better services. There have been many initiatives and partnerships between the government and several companies to ensure the utmost patient care and improve population health in the claim management market. For instance, in 2016, the Ministry of Health and Prevention (MOHAP) renewed its partnership with the Cerner corporation to continue the Wareed project, an enterprise-wide I.T. healthcare system. 

What are the factors hindering the growth rate of the healthcare claims management market?

The expansion of the healthcare claims management market is hindered by the high deployment costs for healthcare claim management, the risk of a data breach, and unproduced patient personal data. Additionally, a barrier to the market's development may be the scarcity of qualified specialists in the sector.

Which segment by type dominated the healthcare claims management market in 2021?

The software segment accounted for the largest share in 2020 and is expected to continue growing during the forecast period. The segment's dominance is due to the convenience and various functions of the software. For example, the software helps in premium billing, eligibility crosschecking, overpayment recovery, capitation, subrogation, etc., helping to provide complete patient satisfaction. Therefore, the usability of the software segment has made it the segment with the most significant share in the market.

Which segment by deployment is expected to have lucrative growth during the forecast period?

The web-based deployment mode is anticipated to contribute significantly to income during the projected time. This dominance is attributable to the popularity and usability of web-based technologies. In addition, the affordability, ease of use, and quick adoption of new technologies by web-based systems, as well as their flexibility and adaptability, promote the expansion of this market. Furthermore, the web-based mode is easily accessible anytime, anywhere, making it a favorable segment.

What is the growth of the healthcare claims management market in various regions?

It is anticipated that the North American market will hold the most considerable portion of the industry during the forecast period. The significant market share of North America is explained by the region's high and expanding HCIT investments and the existence of legislative requirements that encourage the adoption of healthcare claims management solutions. Additionally, the U.S. has several significant international competitors, which has made it a hub for innovation in the healthcare claims management solutions industry. Because more money is being allocated to building the infrastructure for research and healthcare. The market for healthcare claims management in North America is anticipated to increase due to increased investment in healthcare I.T. and partnerships with major players for software development.

Due to supportive government policies surrounding the growth of the healthcare infrastructure and I.T. enterprises in countries like the U.K., Italy, France, Germany, etc. Europe is expected to grow lucratively during the forecast period. 

The market in Asia is expected to have the fastest-growing CAGR throughout the forecast period of 2022-2027. The high growth in Asia during the forecast period is attributed to investments in modernizing the healthcare infrastructure and growing adoption of healthcare I.T. solutions in China, actions to improve the quality of healthcare delivery in Japan, and the brisk growth of the healthcare industry in India.

Who are the key players in the healthcare claims management market?

Accenture PLC, Allscripts Healthcare Solutions, Inc., Athenahealth Inc., Cerner Corporation, Genpact Limited, Health Solutions Plus, IBM Corporation, McKesson Corporation, Optum, Inc., and Oracle Corporation are some of the prominent players in the healthcare claims management market.