市场调查报告书
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1470752
医疗保健支付服务市场:按服务类型、应用程式和最终用户 - 2024-2030 年全球预测Healthcare Payer Services Market by Service Type (Business Process Outsourcing , Information Technology Outsourcing, Knowledge Process Outsourcing ), Application, End User - Global Forecast 2024-2030 |
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预计2023年医疗支付服务市场规模为701.8亿美元,预计2024年将达761.9亿美元,2030年将达1,286.3亿美元,复合年增长率为9.03%。
医疗保健付款人服务包括向健康保险公司、政府机构和其他医疗保健付款人提供的各种第三方服务,以管理其日常业务并提高其服务的效率和成本效益。这些服务包括申请处理、註册、用户管理、提供者网路管理、申请和收款管理、客户服务支援和护理管理支援。慢性病的增加需要引进更好的医疗设施和高效率的管理系统。此外,不断增加的保险申请数量以及政府为扩大医疗报销和保险政策的努力而推动了对高效申请管理解决方案的需求。然而,由于个人健康资讯(PHI)的敏感度而导致的资料隐私问题使得组织很难将资料处理委託给第三方服务提供者。此外,复杂的法规环境可能会对新公司进入该领域构成障碍。然而,领先公司努力采用人工智慧应用、分析和云端基础的服务可能有助于减轻新参与企业的监管负担。该市场的新商机包括将远端医疗整合到按服务收费中,允许付费者透过远端咨询和远端监控设备扩大网路基地台并优化护理服务。
主要市场统计 | |
---|---|
基准年[2023] | 701.8亿美元 |
预测年份 [2024] | 761.9亿美元 |
预测年份 [2030] | 1286.3亿美元 |
复合年增长率(%) | 9.03% |
服务类型:使用业务流程外包 (BPO) 简化医疗保健业务
业务流程外包(BPO)涉及委託各种非核心业务功能,例如保险申请处理、物流、IT业务、薪资核算业务和登记服务。医疗保健提供者通常选择 BPO 来降低成本、简化流程并专注于核心能力。资讯科技外包(ITO)专注于IT相关业务的外包,包括基础设施管理、应用开发和维护、网路安全服务、云端处理解决方案、资料分析以及IT和通讯服务。知识流程外包(KPO)是将业务外包给通常具有高度专业知识的专业人员。某些影像检查和服务(例如 X 光和磁振造影(MRI))的结果可以发送给 KPO 组织进行分析。 KPO也深入参与研发活动和实验活动的资料分析。
简化应用保险相关业务的保险申请管理服务的要求
在医疗保健支付服务产业,分析和欺诈管理在确保系统完整性和降低成本方面发挥关键作用。先进的演算法和资料分析使公司能够识别诈欺、浪费和滥用的模式,最终保护付款人和患者免受不必要的经济负担。申请和会计管理对于简化医疗保健付款人的收益週期流程至关重要。专门从事这一领域的公司帮助付款人减少申请错误并改善现金流。申请管理对于医疗保健付款人服务至关重要,因为它可以确保及时报销医疗保健提供者提供的医疗程序。人力资源服务管理是医疗保健付款人服务的重要组成部分,可确保高效的人才招募、入职、薪资管理、社会福利管理、法律规章合规等。整合前台服务和后勤部门业务会员管理部门由提供综合解决方案的公司组成,这些解决方案将前台服务(例如客服中心支援、註册协助和病人参与)与后勤部门业务(例如 IT业务和会计)整合在一起。将会完成。提供者网路管理为会员提供经济高效的护理,推动网路设计改进,并整合患者资料,例如护理计划、测试结果和医疗申请。
最终用户:人们对高效医疗保健系统重要性的认识不断提高,正在推动公众和政府付款人的参与。
商业性付款人是透过雇主或个人购买向个人提供健康保险的营利实体。有竞争力的付款人通常专注于有竞争力的价格、管理效率和创新解决方案,以最好地为患者服务。私人付款人由非营利组织组成,这些组织向在政府资助计划之外寻求补充保险的个人和组织提供健康保险单。其主要目标是提供负担得起的医疗保健,重点是个人化护理管理计划。公共或政府付款人由纳税人资助,专注于为特定人群提供医疗保健保险,例如低收入者、老年人、身障者和退伍军人。优先考虑具有成本效益的解决方案,确保获得基本服务并解决健康的社会决定因素。
区域洞察
在美洲,人们强调基于价值的照护模式,并且对具有成本效益的医疗支付服务的需求不断增长。在美国,领先的公司正在透过创新解决方案主导该领域,以满足不断变化的保险格局。同时,由于数位医疗平台的最新进展,加拿大的分散式公共卫生系统支持全民健康覆盖。此外,人工智慧 (AI)、巨量资料分析和远端医疗技术创新正在为医疗保健付款组织创造机会,在降低成本的同时提供更好的患者治疗结果。欧盟国家拥有多样化的医疗保健系统,并具有不同程度的官民合作关係。包括欧洲药品管理局 (EMA) 在内的监管机构为医疗保健和医疗机构制定了指导方针,重点是资料主导的决策和个人化医疗。在亚太地区,推动医疗支付服务采用的因素包括对私人医疗保险的需求增加、政府促进获得增强医疗保健解决方案的倡议以及对医疗保健选择的认识提高。中国快速老化的人口需要创新的慢性病管理解决方案,而日本的全民健保体系则专注于数位转型。
FPNV定位矩阵
FPNV 定位矩阵对于评估医疗支付服务市场至关重要。我们检视与业务策略和产品满意度相关的关键指标,以对供应商进行全面评估。这种深入的分析使用户能够根据自己的要求做出明智的决策。根据评估,供应商被分为四个成功程度不同的像限:前沿(F)、探路者(P)、利基(N)和重要(V)。
市场占有率分析
市场占有率分析是一种综合工具,可以对医疗保健付款服务市场中供应商的现状进行深入而详细的研究。全面比较和分析供应商在整体收益、基本客群和其他关键指标方面的贡献,以便更好地了解公司的绩效及其在争夺市场占有率时面临的挑战。此外,该分析还提供了对该行业竞争特征的宝贵见解,包括在研究基准年观察到的累积、分散主导地位和合併特征等因素。详细程度的提高使供应商能够做出更明智的决策并制定有效的策略,从而在市场上获得竞争优势。
1. 市场渗透率:提供有关主要企业所服务的市场的全面资讯。
2. 市场开拓:我们深入研究利润丰厚的新兴市场,并分析其在成熟细分市场的渗透率。
3. 市场多元化:提供有关新产品发布、开拓地区、最新发展和投资的详细资讯。
4.竞争力评估与资讯:对主要企业的市场占有率、策略、产品、认证、监管状况、专利状况、製造能力等进行全面评估。
5. 产品开发与创新:提供对未来技术、研发活动和突破性产品开发的见解。
1.医疗支付服务市场的市场规模与预测是多少?
2.在医疗保健支付服务市场的预测期内,需要考虑投资哪些产品、细分市场、应用程式和领域?
3. 医疗支付服务市场的技术趋势和法规结构是什么?
4.医疗支付服务市场主要供应商的市场占有率是多少?
5. 进入医疗支付服务市场的适当型态和策略手段是什么?
[198 Pages Report] The Healthcare Payer Services Market size was estimated at USD 70.18 billion in 2023 and expected to reach USD 76.19 billion in 2024, at a CAGR 9.03% to reach USD 128.63 billion by 2030.
The healthcare payer services encompass a wide range of third-party services provided to health insurance companies, government agencies, and other healthcare payers to help them manage their daily operations and improve the efficiency and cost-effectiveness of their services. These services include claims processing, member enrollment, benefits management, provider network management, billing and collection management, customer service support, and care management support. The rising prevalence of chronic diseases has necessitated the deployment of better healthcare facilities and efficient management systems. Additionally, the growing number of insurance claims and efforts by the government to expand access to healthcare reimbursement and insurance policies create a need for efficient claims management solutions. However, data privacy concerns due to the sensitive nature of personal health information (PHI) can make it difficult for organizations to trust third-party service providers to handle their data. Additionally, complex regulatory environments may pose entry barriers for new players in this space. However, efforts by major players to incorporate AI-enabled applications, analytics, and cloud-based services can help reduce the regulatory burden on new entrants. Emerging opportunities within this market include the integration of telehealth into payer service offerings, which can help payers expand access points and optimize care delivery through remote consultations or remote monitoring devices.
KEY MARKET STATISTICS | |
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Base Year [2023] | USD 70.18 billion |
Estimated Year [2024] | USD 76.19 billion |
Forecast Year [2030] | USD 128.63 billion |
CAGR (%) | 9.03% |
Service Type: Utilizing business process outsourcing (BPO) to streamline healthcare operations
Business Process Outsourcing (BPO) involves contracting out various non-core business functions such as claims processing, logistics, IT operations, payroll activities, and enrollment services. Healthcare payers frequently choose BPO to achieve cost savings, streamline processes, and focus on core competencies. Information Technology Outsourcing (ITO) focuses on outsourcing IT-related tasks such as infrastructure management, application development and maintenance, cybersecurity services, cloud computing solutions, data analytics, and telecommunication services, among others. Knowledge Process Outsourcing (KPO) involves outsourcing tasks to a professional workforce that typically has advanced expertise in a specialized area. The results of certain imaging tests or services, including X-rays and magnetic resonance imaging(MRIs), can be sent to the KPO organization for analysis. KPOs are also heavily involved in R&D activities and data analysis on experimental activities.
Application: Requirement of claim management services to facilitate efficient insurance-related operations
In the healthcare payer services industry, analytics and fraud management play a crucial role in ensuring the integrity of the system and reducing costs. Through advanced algorithms and data analysis, companies can identify patterns of fraud, waste, and abuse, ultimately protecting both payers and patients from unnecessary financial burdens. Billing and accounts management is essential for streamlining revenue cycle processes for healthcare payers. Companies specializing in this area help payers reduce billing errors and improve cash flow. Claims management is integral to healthcare payer services as it ensures timely reimbursement for medical treatments provided by care providers. HR services management is an essential component of healthcare payer services that ensures efficient talent acquisition, onboarding, payroll administration, benefits management, and regulatory compliance, among others. The integrated front-office service & back-office operations member management segment comprises companies providing comprehensive solutions that integrate front-office services such as call center support, enrollment assistance, and patient engagement with back-office operations such as IT operations and accounting. Provider network management involves bringing cost-effective care to members, driving network design improvements, and consolidating patients' data, including care plans, lab results, and medical claims.
End-user: Growing awareness about importance of efficient healthcare systems driving public and government payers' involvement
Commercial payers are for-profit entities that provide health insurance coverage to individuals through employers or private purchases. Commercial payers typically focus on competitive pricing, administrative efficiency, and innovative solutions to provide optimum service to patients. Private payers consist of non-profit organizations providing health insurance policies to individuals or groups seeking supplemental coverage outside of government-sponsored programs. Their primary goal is to offer affordable healthcare access with a focus on personalized care management programs. Public or government payers are funded by taxpayers and focus on providing healthcare coverage to specific population segments such as low-income individuals, the elderly, disabled, and veterans. They prioritize cost-effective solutions, ensuring access to essential services, and addressing social determinants of health.
Regional Insights
The Americas region has a strong focus on value-based care models and an increasing demand for cost-effective healthcare payer services. The U.S. has seen major companies dominating the sector with innovative solutions to cater to the ever-evolving insurance landscape. Meanwhile, Canada's decentralized and publicly funded health system supports universal healthcare coverage for its citizens with recent advances in digital health platforms. Additionally, technological innovations such as artificial intelligence (AI), big data analytics, and telemedicine are creating opportunities for healthcare payer organizations to deliver better patient outcomes while reducing costs. EU countries have diverse healthcare systems with varying degrees of public-private partnerships. Regulatory bodies, including the European Medicines Agency (EMA), set guidelines for healthcare and medicine facilities and create emphasis on data-driven decision-making and personalized medicine. In the APAC region, factors driving healthcare payer services adoption include increasing demand for private health insurance, governmental initiatives to propel access to enhanced healthcare solutions, and heightened awareness about healthcare options. China's rapidly aging population requires innovative solutions for chronic disease management, while Japan's universal health care system is focusing on digital transformation.
FPNV Positioning Matrix
The FPNV Positioning Matrix is pivotal in evaluating the Healthcare Payer Services Market. It offers a comprehensive assessment of vendors, examining key metrics related to Business Strategy and Product Satisfaction. This in-depth analysis empowers users to make well-informed decisions aligned with their requirements. Based on the evaluation, the vendors are then categorized into four distinct quadrants representing varying levels of success: Forefront (F), Pathfinder (P), Niche (N), or Vital (V).
Market Share Analysis
The Market Share Analysis is a comprehensive tool that provides an insightful and in-depth examination of the current state of vendors in the Healthcare Payer Services Market. By meticulously comparing and analyzing vendor contributions in terms of overall revenue, customer base, and other key metrics, we can offer companies a greater understanding of their performance and the challenges they face when competing for market share. Additionally, this analysis provides valuable insights into the competitive nature of the sector, including factors such as accumulation, fragmentation dominance, and amalgamation traits observed over the base year period studied. With this expanded level of detail, vendors can make more informed decisions and devise effective strategies to gain a competitive edge in the market.
Key Company Profiles
The report delves into recent significant developments in the Healthcare Payer Services Market, highlighting leading vendors and their innovative profiles. These include AArete LLC, Accenture PLC, Acurus Solutions, Inc., Anthem Insurance Companies, Inc., athenahealth, Inc., Atos SE, CitiusTech Inc., Clarus RCM, Cognizant Technology Solutions, Concentrix Corporation, Conduent, Inc., Connvertex Technologies Inc., Dell, Inc., ExlService Holdings, Inc., Firstsource Solutions Limited, Genpact Limited, HCL Technologies Limited, Hewlett Packard Enterprise Company, Hexaware Technologies Limited, Hinduja Global Solutions Limited, Infosys Limited, International Business Machines Corporation, Invensis Technologies Pvt. Ltd., IQVIA Inc., Kiriworks, Inc., Mobisoft Infotech LLC, Mphasis, Newgen Software Technologies Limited, Nous Infosystems Pvt. Ltd., NTT DATA Corporation, OSP Labs, Pegasystems Inc., PricewaterhouseCoopers LLP, Protiviti Inc., R1 RCM Inc., Ricoh Company, Ltd., ServiceNow, Inc., System Soft Technologies LLC, TATA Consultancy Services Limited, Tech Mahindra Limited, Tegria Holdings LLC, Unimrkt Healthcare LLP, Unitedhealth Group, Vee Technologies, Viaante Business Solutions, VMware, Inc., Wipro Limited, WNS Limited, and Xerox Corporation.
Market Segmentation & Coverage
1. Market Penetration: It presents comprehensive information on the market provided by key players.
2. Market Development: It delves deep into lucrative emerging markets and analyzes the penetration across mature market segments.
3. Market Diversification: It provides detailed information on new product launches, untapped geographic regions, recent developments, and investments.
4. Competitive Assessment & Intelligence: It conducts an exhaustive assessment of market shares, strategies, products, certifications, regulatory approvals, patent landscape, and manufacturing capabilities of the leading players.
5. Product Development & Innovation: It offers intelligent insights on future technologies, R&D activities, and breakthrough product developments.
1. What is the market size and forecast of the Healthcare Payer Services Market?
2. Which products, segments, applications, and areas should one consider investing in over the forecast period in the Healthcare Payer Services Market?
3. What are the technology trends and regulatory frameworks in the Healthcare Payer Services Market?
4. What is the market share of the leading vendors in the Healthcare Payer Services Market?
5. Which modes and strategic moves are suitable for entering the Healthcare Payer Services Market?