Healthcare Fraud Detection Market Report by Component, Type, Delivery Mode, Application, End User, and Region 2024-2032
세계의 헬스케어 부정 탐지 시장 규모는 2023년에 25억 달러에 달했습니다. 향후 IMARC Group은 시장이 2032년까지 140억 달러에 달하며, 2024-2032년 20.7%의 성장률(CAGR)을 보일 것으로 예측하고 있습니다.
헬스케어 부정 탐지는 청구 프로세스의 모든 단계에서 의료 부정, 낭비, 남용을 감지하고 방지하여 부적절한 지불을 줄이는 데 도움을 줍니다. 기존 지불 무결성 솔루션을 연결하고 청구 시스템, 감시 리스트, 제3자 기관, 비정형 텍스트 등 내부 및 외부 소스의 데이터를 통합하여 효율적인 데이터 관리를 실현합니다. 최신 통계, 머신러닝(ML), 딥러닝, 텍스트 분석 알고리즘 등 다양한 고급 분석 기술과 인공지능(AI) 기술에 의존합니다. 이와는 별도로 운영, 임상 및 연구 평가를 지원하고 모든 관련 사례 정보를 저장하는 유연한 프로세스를 사용합니다.
헬스케어 부정 탐지 시장 동향 :
건강보험을 찾는 환자가 증가함에 따라 의료 사기 탐지 솔루션에 대한 수요가 증가하고 있습니다. 이는 헬스케어 산업에서 선불 심사 모델의 확대와 함께 시장을 촉진하는 중요한 요인 중 하나입니다. 또한 전 세계에서 약국 청구 관련 부정행위가 증가하고 있는 것도 시장 성장을 가속하고 있습니다. 또한 부정행위를 식별하기 위한 생체 인식 센서가 장착된 솔루션에 대한 수요도 증가하고 있습니다. 이는 특히 신흥 국가에서 헬스케어 부정행위 분석의 도입이 증가하면서 시장에 긍정적인 영향을 미치고 있습니다. 이와 더불어, 의료 사기 탐지 분야에서 인공지능(AI)의 통합이 증가함에 따라 업계 투자자들에게 유리한 성장 기회를 제공합니다. 이와는 별도로 여러 국가의 정부는 의료 보험 청구를 검토하여 소비자와 국가 재정을 절약하기 위한 노력을 기울이고 있습니다. 이에 따라 급성장하는 헬스케어 산업이 시장 성장을 촉진하고 있습니다. 기타 성장 요인으로는 투자수익률(ROI) 상승, 소셜미디어 사용 증가, 여러 정보기술(IT) 플랫폼 도입을 위한 자금 조달 등을 들 수 있습니다.
목차
제1장 서문
제2장 조사 범위와 조사 방법
- 조사 목적
- 이해관계자
- 데이터 소스
- 시장 추정
- 조사 방법
제3장 개요
제4장 서론
제5장 세계의 헬스케어 부정 탐지 시장
- 시장 개요
- 시장 실적
- COVID-19의 영향
- 시장 예측
제6장 시장 내역 : 컴포넌트별
제7장 시장 내역 : 유형별
제8장 시장 내역 : 제공 모드별
제9장 시장 내역 : 용도별
제10장 시장 내역 : 최종사용자별
제11장 시장 내역 : 지역별
- 북미
- 아시아태평양
- 유럽
- 독일
- 프랑스
- 영국
- 이탈리아
- 스페인
- 러시아
- 기타
- 라틴아메리카
- 중동 및 아프리카
제12장 SWOT 분석
제13장 밸류체인 분석
제14장 Porter's Five Forces 분석
- 개요
- 바이어의 교섭력
- 공급 기업의 교섭력
- 경쟁의 정도
- 신규 진출업체의 위협
- 대체품의 위협
제15장 가격 분석
제16장 경쟁 구도
- 시장 구조
- 주요 기업
- 주요 기업의 개요
- CGI Inc.
- Conduent Inc.
- ExlService Holdings Inc.
- Fair Isaac Corporation
- HCL Technologies Limited
- International Business Machines Corporation
- Northrop Grumman Corporation
- RELX Group plc
- SAS Institute Inc.
- UnitedHealth Group
- Wipro Ltd.
KSA
The global healthcare fraud detection market size reached US$ 2.5 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.0 Billion by 2032, exhibiting a growth rate (CAGR) of 20.7% during 2024-2032.
Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.
Healthcare Fraud Detection Market Trends:
Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.
Key Market Segmentation:
IMARC Group provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market report, along with forecasts at the global, regional and country level from 2024-2032. Our report has categorized the market based on component, type, delivery mode, application and end user.
Breakup by Component:
Software
Services
Breakup by Type:
Descriptive Analytics
Predictive Analytics
Prescriptive Analytics
Breakup by Delivery Mode:
On-premises
On-demand
Breakup by Application:
Insurance Claims Review
Payment Integrity
Breakup by End User:
Private Insurance Payers
Government Agencies
Others
Breakup by Region:
North America
United States
Canada
Asia-Pacific
China
Japan
India
South Korea
Australia
Indonesia
Others
Europe
Germany
France
United Kingdom
Italy
Spain
Russia
Others
Latin America
Brazil
Mexico
Others
Middle East and Africa
Competitive Landscape:
The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.
Key Questions Answered in This Report:
- How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?
- What has been the impact of COVID-19 on the global healthcare fraud detection market?
- What are the key regional markets?
- What is the breakup of the market based on the component?
- What is the breakup of the market based on the type?
- What is the breakup of the market based on the delivery mode?
- What is the breakup of the market based on the application?
- What is the breakup of the market based on the end user?
- What are the various stages in the value chain of the industry?
- What are the key driving factors and challenges in the industry?
- What is the structure of the global healthcare fraud detection market and who are the key players?
- What is the degree of competition in the industry?
Table of Contents
1 Preface
2 Scope and Methodology
- 2.1 Objectives of the Study
- 2.2 Stakeholders
- 2.3 Data Sources
- 2.3.1 Primary Sources
- 2.3.2 Secondary Sources
- 2.4 Market Estimation
- 2.4.1 Bottom-Up Approach
- 2.4.2 Top-Down Approach
- 2.5 Forecasting Methodology
3 Executive Summary
4 Introduction
- 4.1 Overview
- 4.2 Key Industry Trends
5 Global Healthcare Fraud Detection Market
- 5.1 Market Overview
- 5.2 Market Performance
- 5.3 Impact of COVID-19
- 5.4 Market Forecast
6 Market Breakup by Component
- 6.1 Software
- 6.1.1 Market Trends
- 6.1.2 Market Forecast
- 6.2 Services
- 6.2.1 Market Trends
- 6.2.2 Market Forecast
7 Market Breakup by Type
- 7.1 Descriptive Analytics
- 7.1.1 Market Trends
- 7.1.2 Market Forecast
- 7.2 Predictive Analytics
- 7.2.1 Market Trends
- 7.2.2 Market Forecast
- 7.3 Prescriptive Analytics
- 7.3.1 Market Trends
- 7.3.2 Market Forecast
8 Market Breakup by Delivery Mode
- 8.1 On-premises
- 8.1.1 Market Trends
- 8.1.2 Market Forecast
- 8.2 On-demand
- 8.2.1 Market Trends
- 8.2.2 Market Forecast
9 Market Breakup by Application
- 9.1 Insurance Claims Review
- 9.1.1 Market Trends
- 9.1.2 Market Forecast
- 9.2 Payment Integrity
- 9.2.1 Market Trends
- 9.2.2 Market Forecast
10 Market Breakup by End User
- 10.1 Private Insurance Payers
- 10.1.1 Market Trends
- 10.1.2 Market Forecast
- 10.2 Government Agencies
- 10.2.1 Market Trends
- 10.2.2 Market Forecast
- 10.3 Others
- 10.3.1 Market Trends
- 10.3.2 Market Forecast
11 Market Breakup by Region
- 11.1 North America
- 11.1.1 United States
- 11.1.1.1 Market Trends
- 11.1.1.2 Market Forecast
- 11.1.2 Canada
- 11.1.2.1 Market Trends
- 11.1.2.2 Market Forecast
- 11.2 Asia-Pacific
- 11.2.1 China
- 11.2.1.1 Market Trends
- 11.2.1.2 Market Forecast
- 11.2.2 Japan
- 11.2.2.1 Market Trends
- 11.2.2.2 Market Forecast
- 11.2.3 India
- 11.2.3.1 Market Trends
- 11.2.3.2 Market Forecast
- 11.2.4 South Korea
- 11.2.4.1 Market Trends
- 11.2.4.2 Market Forecast
- 11.2.5 Australia
- 11.2.5.1 Market Trends
- 11.2.5.2 Market Forecast
- 11.2.6 Indonesia
- 11.2.6.1 Market Trends
- 11.2.6.2 Market Forecast
- 11.2.7 Others
- 11.2.7.1 Market Trends
- 11.2.7.2 Market Forecast
- 11.3 Europe
- 11.3.1 Germany
- 11.3.1.1 Market Trends
- 11.3.1.2 Market Forecast
- 11.3.2 France
- 11.3.2.1 Market Trends
- 11.3.2.2 Market Forecast
- 11.3.3 United Kingdom
- 11.3.3.1 Market Trends
- 11.3.3.2 Market Forecast
- 11.3.4 Italy
- 11.3.4.1 Market Trends
- 11.3.4.2 Market Forecast
- 11.3.5 Spain
- 11.3.5.1 Market Trends
- 11.3.5.2 Market Forecast
- 11.3.6 Russia
- 11.3.6.1 Market Trends
- 11.3.6.2 Market Forecast
- 11.3.7 Others
- 11.3.7.1 Market Trends
- 11.3.7.2 Market Forecast
- 11.4 Latin America
- 11.4.1 Brazil
- 11.4.1.1 Market Trends
- 11.4.1.2 Market Forecast
- 11.4.2 Mexico
- 11.4.2.1 Market Trends
- 11.4.2.2 Market Forecast
- 11.4.3 Others
- 11.4.3.1 Market Trends
- 11.4.3.2 Market Forecast
- 11.5 Middle East and Africa
- 11.5.1 Market Trends
- 11.5.2 Market Breakup by Country
- 11.5.3 Market Forecast
12 SWOT Analysis
- 12.1 Overview
- 12.2 Strengths
- 12.3 Weaknesses
- 12.4 Opportunities
- 12.5 Threats
13 Value Chain Analysis
14 Porters Five Forces Analysis
- 14.1 Overview
- 14.2 Bargaining Power of Buyers
- 14.3 Bargaining Power of Suppliers
- 14.4 Degree of Competition
- 14.5 Threat of New Entrants
- 14.6 Threat of Substitutes
15 Price Analysis
16 Competitive Landscape
- 16.1 Market Structure
- 16.2 Key Players
- 16.3 Profiles of Key Players
- 16.3.1 CGI Inc.
- 16.3.1.1 Company Overview
- 16.3.1.2 Product Portfolio
- 16.3.1.3 Financials
- 16.3.1.4 SWOT Analysis
- 16.3.2 Conduent Inc.
- 16.3.2.1 Company Overview
- 16.3.2.2 Product Portfolio
- 16.3.2.3 Financials
- 16.3.2.4 SWOT Analysis
- 16.3.3 ExlService Holdings Inc.
- 16.3.3.1 Company Overview
- 16.3.3.2 Product Portfolio
- 16.3.3.3 Financials
- 16.3.4 Fair Isaac Corporation
- 16.3.4.1 Company Overview
- 16.3.4.2 Product Portfolio
- 16.3.4.3 Financials
- 16.3.4.4 SWOT Analysis
- 16.3.5 HCL Technologies Limited
- 16.3.5.1 Company Overview
- 16.3.5.2 Product Portfolio
- 16.3.5.3 Financials
- 16.3.5.4 SWOT Analysis
- 16.3.6 International Business Machines Corporation
- 16.3.6.1 Company Overview
- 16.3.6.2 Product Portfolio
- 16.3.6.3 Financials
- 16.3.7 Northrop Grumman Corporation
- 16.3.7.1 Company Overview
- 16.3.7.2 Product Portfolio
- 16.3.7.3 Financials
- 16.3.7.4 SWOT Analysis
- 16.3.8 RELX Group plc
- 16.3.8.1 Company Overview
- 16.3.8.2 Product Portfolio
- 16.3.8.3 Financials
- 16.3.8.4 SWOT Analysis
- 16.3.9 SAS Institute Inc.
- 16.3.9.1 Company Overview
- 16.3.9.2 Product Portfolio
- 16.3.9.3 SWOT Analysis
- 16.3.10 UnitedHealth Group
- 16.3.10.1 Company Overview
- 16.3.10.2 Product Portfolio
- 16.3.10.3 Financials
- 16.3.10.4 SWOT Analysis
- 16.3.11 Wipro Ltd.
- 16.3.11.1 Company Overview
- 16.3.11.2 Product Portfolio
- 16.3.11.3 Financials
