Stratistics MRC에 따르면 세계의 의료비 환급 시장은 2025년에 315억 9,000만 달러를 차지하고, 2032년에는 1,151억 9,000만 달러에 이를 것으로 예측됩니다.
클리닉, 병원, 의사와 같은 건강 관리 제공업체는 보험 회사, 메디케어 및 메디케이드와 같은 정부 이니셔티브 또는 환자로부터 직접 서비스에 대한 지불을 받는 과정을 의료비 환급으로 알려져 있습니다. 수술에 이르기까지 제공된 서비스에 대한 지불을 받을 수 있습니다.
미국의학협회(AMA)에 따르면 2023년 미국의 의료비 지출은 실제로 7.5% 증가하여 1인당 4조 9,000억 달러, 즉 14,570달러에 달했습니다. 이 증가율은 2022년의 4.6% 증가율보다 현저히 높은 수치이며, 코로나19 팬데믹으로 인한 2020년의 10.4% 증가를 제외하면 2003년 이후 가장 높은 수치입니다.
만성 질환 유병률 증가
세계적으로 당뇨병, 암, 심장병 등의 만성 질환은 사망이나 신체장애의 원인의 상위에 랭크되고 있습니다. 지속적인 케어, 의사의 정기적인 진찰, 처방약, 때로는 입원이 필요하게 되는 경우가 많습니다.
복잡하고 화려한 진료 보상 프레임 워크
지불 주체(민간인가 공적인가), 서비스의 유형, 인구 통계에 의해 헬스 케어 상환 정책은 국가간, 나아가 국가내에서도 크게 달라집니다. 효율성, 청구 실수, 환자와 의료인 간의 오해는 이러한 일관성 부족으로 인해 발생합니다.
디지털 건강과 원격 의료 서비스 개발
특히 COVID-19 팬데믹의 중과 그 후, 원격 의료가 급속히 보급되었기 때문에 진료 보수가 늘어날 가능성이 큽니다. 협회에 의하면, 원격 의료 이용률은 팬데믹 전의 38배의 수준으로 안정되어 있습니다. 이러한 서비스의 보험 적용을 확대하는 것으로, 의료 격차를 시정해, 지방에서의 액세스를 강화해, 제도적 부담을 경감하는 것으로, 장기적으로는 진료 보수 시장을 성장시킬 수 있습니다.
사이버 보안 및 데이터 유출 위험
디지털 플랫폼은 의료 시스템에서 청구 워크플로우를 처리하고, 환자의 개인 정보를 저장하고, 진료 보상 청구를 처리하는 데 필수적입니다. 또한 미국 보건사회복지성(HHS)에 따르면 의료 데이터 침해의 보고 건수는 꾸준히 증가하고 있으며, 2023년에만 700건 이상의 침해가 1억 3,300만명 이상에 영향을 미쳤습니다.
COVID-19의 대유행은 세계의 상환 모델을 크게 바꾸고, 규제의 유연화를 촉구하고, 디지털 헬스 서비스로의 이행을 가속화해, 이들 모두가 헬스 케어 상환 시장에 영향을 주었습니다. 이전에는 환급이 미미하거나 제외되었던 원격 의료, 원격 모니터링, 재택 간호 서비스가 의료 시스템의 부담이 커지면서 정부와 보험사로부터 빠르게 보험 적용을 받게 되었습니다. 가상 진찰에 대해서는 미국 메디케어 & 메디케이드 서비스 센터(CMS)가 실시한 것과 같은 일시적인 정책 변경에 의해 지불의 평준화와 청구 코드의 확대 대규모가 가능해졌습니다. 또한, 이러한 변화는 처음에는 긴급 조치였음에도 불구하고, 디지털 및 가치 기반 상환은 현재 건강 관리 생태계에 뿌리를 두고 있습니다.
예측 기간 동안 완전 지불형 부문이 최대가 될 것으로 예상
완전 지불형 부문은 예측 기간 동안 최대 시장 점유율을 차지할 것으로 예측됩니다. 결제를 통해 이 분야는 시장의 상당 부분을 차지하고 있습니다. 또한, 완제 청구는 특히 건강 관리 비용 증가와 의료 계획의 복잡성에 비추어 환자와 의료 제공업체가 의료 서비스 지불에 필요한 자금을 확보하고 있음을 보장합니다.
예측 기간 동안 CAGR이 가장 높을 것으로 예상되는 것은 의원 부문입니다.
예측 기간 동안 가장 높은 성장률을 보일 것으로 예상되는 것은 의원 부문입니다. 인구의 고령화, 만성 질환의 이환율 증가, 외래 진료의 요구 증가가 이 성장을 가속하는 요인의 일부입니다. 또한, 원격 의료의 개발과 밸류 베이스 케어 모델로의 이행이, 의원이 제공하는 서비스에 수요를 높여 가고 있습니다.
예측 기간 동안 북미가 최대 시장 점유율을 차지할 것으로 예측됩니다. 또한 건강보험개혁법과 같은 법률의 시행으로 환급 시스템이 강화되어 의료 서비스에 대한 접근성이 향상되었습니다.
예측 기간 동안 아시아태평양이 가장 높은 CAGR을 나타낼 것으로 예측됩니다. 의료비의 증대, 만성 질환 증가, 신흥국에서의 보험 적용 범위의 확대 등이, 이 급성장을 뒷받침하는 요인의 하나입니다. 중국과 인도와 같은 국가에서는 의료 인프라에 많은 투자를 하고 있으므로 상환 서비스에 대한 수요가 증가하고 있습니다. 게다가 이 지역 시장은 공적·사적 보험 제도의 확대나 디지털 헬스 기술의 채용에 의해 확대하고 있습니다.
According to Stratistics MRC, the Global Healthcare Reimbursement Market is accounted for $31.59 billion in 2025 and is expected to reach $115.19 billion by 2032 growing at a CAGR of 20.3% during the forecast period. The process through which healthcare providers-such as clinics, hospitals, or doctors-are paid for their services by insurance companies, government initiatives like Medicare and Medicaid, or directly from patients is known as healthcare reimbursement. This system guarantees that healthcare professionals receive payment for the services they provide, ranging from standard examinations to intricate surgical operations. Different reimbursement models, such as capitation, value-based care, bundled payments, and fee-for-service, have varying effects on provider incentives, cost control, and care quality.
According to the American Medical Association (AMA), U.S. health spending indeed increased by 7.5% in 2023, reaching $4.9 trillion or $14,570 per capita. This growth rate is notably higher than the 4.6% rise in 2022 and is the highest observed since 2003, apart from the 10.4% rise in 2020 due to the COVID-19 pandemic
Increasing chronic illness prevalence
Globally, chronic diseases like diabetes, cancer, and heart disease rank among the top causes of death and disability. Non-communicable diseases are responsible for about 74% of all deaths globally, according to the World Health Organization (WHO). Additionally, these illnesses frequently necessitate continuous care, regular checkups with the doctor, prescription drugs, and occasionally hospitalization. In order to assist patients and healthcare systems in controlling the long-term costs of care, there is a growing need for comprehensive and ongoing reimbursement frameworks.
Complicated and disjointed reimbursement frameworks
Depending on the payer (private vs. public), the service type, and the demographic, healthcare reimbursement policies differ significantly between nations and even within them. Medicare, Medicaid, and private insurers are subject to different regulations in the United States. Furthermore, administrative inefficiencies, billing errors, and misunderstandings between patients and providers are caused by this lack of consistency. Complicated documentation requirements, coding specifications, and authorization processes can cause payment delays and deter providers from taking part in specific reimbursement programs.
Development of digital health and telehealth services
There is a significant chance for reimbursement growth due to the quick uptake of telemedicine, particularly during and after the COVID-19 pandemic. More and more, governments and insurance companies are incorporating mobile health apps, remote monitoring, and virtual consultations into their reimbursement schemes. Moreover, telehealth utilization has stabilized at 38 times higher levels than it was prior to the pandemic, according to the American Hospital Association. By increasing coverage for these services, the reimbursement market can grow in the long run by lowering healthcare disparities, enhancing access in rural areas, and relieving systemic burdens.
Risks to cyber security and data breach
Digital platforms are essential for handling billing workflows, storing private patient information, and processing reimbursement claims in healthcare systems. The industry is particularly vulnerable to cyber attacks because of this dependence. A single data breach has the potential to stop operations and jeopardize thousands of patient records. Additionally, the number of reported healthcare data breaches has been increasing steadily, with over 700 breaches impacting over 133 million people in 2023 alone, according to the U.S. Department of Health and Human Services (HHS). These occurrences damage public confidence and raise the expense of security and compliance.
The COVID-19 pandemic significantly altered global reimbursement models, prompted regulatory flexibility, and accelerated the transition to digital health services, all of which had an effect on the healthcare reimbursement market. Telehealth, remote monitoring, and home-based care-services that were previously under-reimbursed or excluded-were quickly covered by governments and insurers as healthcare systems became overburdened. For virtual consultations, temporary policy changes, like those implemented by the U.S. Centers for Medicare & Medicaid Services (CMS), allowed for payment parity and wider billing codes. Furthermore, digital and value-based reimbursement is now more ingrained in the healthcare ecosystem, despite the fact that these changes were initially emergency measures.
The fully paid segment is expected to be the largest during the forecast period
The fully paid segment is expected to account for the largest market share during the forecast period. Fully paid claims are medical reimbursements that have been processed and paid in full by insurance companies or medical providers in accordance with the terms of the health plan. Given that it shows the effective settlement of healthcare costs without leaving the patient with any outstanding balance, this segment accounts for a sizeable portion of the market. Moreover, fully paid claims guarantee that patients and providers have the money needed to pay for medical services, especially in light of rising healthcare costs and the complexity of healthcare plans.
The physician offices segment is expected to have the highest CAGR during the forecast period
Over the forecast period, the physician offices segment is predicted to witness the highest growth rate. The aging of the population, the growing incidence of chronic illnesses, and the increased need for outpatient care are some of the factors driving this growth. Physician offices' growing role in the healthcare system is a result of their ability to provide affordable care and play a key role in managing chronic conditions. Furthermore, telemedicine developments and the move to value-based care models have increased demand for services rendered by doctors' offices. In the context of healthcare reimbursement, this market segment is therefore expected to grow at the fastest rate.
During the forecast period, the North America region is expected to hold the largest market share. The United States, which alone accounts for roughly 38.7% of the global market, is principally responsible for this dominance. This top ranking is largely due to the region's strong healthcare system, extensive insurance coverage, and sophisticated reimbursement schemes. Additionally, the reimbursement systems have been reinforced by the implementation of laws such as the Affordable Care Act, guaranteeing greater access to medical care.
Over the forecast period, the Asia Pacific region is anticipated to exhibit the highest CAGR. Growing healthcare costs, the occurrence of more chronic illnesses, and the expansion of insurance coverage in emerging economies are some of the factors driving this quick growth. Because of their significant investments in healthcare infrastructure, nations like China and India are seeing an increase in demand for reimbursement services. Furthermore, the region's market is expanding due to the expansion of both public and private insurance programs as well as the adoption of digital health technologies.
Key players in the market
Some of the key players in Healthcare Reimbursement Market include Anthem, Inc, Cigna Corporation, Nippon Life Insurance Company Limited, Aetna Inc., Humana Inc., CVS Health Corporation, Allianz Care (Allianz Group), Molina Healthcare, Inc., Centene Corporation, Agile Health Insurance, WellCare Health Plans, Inc., UnitedHealth Group Incorporated, Health Care Service Corporation (HCSC), Aviva plc and MetLife, Inc.
In April 2025, Cigna Healthcare and Mercy Health have reached a multi-year agreement, ensuring that Cigna's commercially insured patients will remain in-network at Mercy Health facilities in Ohio. The agreement, effective, averts a potential disruption in healthcare access that had been looming as contract negotiations between the two entities stretched past multiple deadlines.
In December 2024, Nippon Life Insurance Company has agreed to consolidate its ownership interest in Resolution Life by acquiring the remaining shares from the firm's investment limited partnership for $8.2 billion. The transaction values Resolution Life at $10.6 billion, with shareholders also retaining final dividends before completion.
In July 2024, Humana Inc. announced a new multi-year agreement with Google Cloud to further modernize Humana's cloud infrastructure and leverage cutting-edge AI capabilities to accelerate innovation in healthcare. This agreement builds on an ongoing collaboration between Google Health and Humana to co-develop solutions focused on population health and bringing the best of Google's AI technologies and products to Humana members and patients.