세계의 의료비 지불자 솔루션 시장 보고서(2025년)
Healthcare Payer Solution Global Market Report 2025
상품코드 : 1821680
리서치사 : The Business Research Company
발행일 : On Demand Report
페이지 정보 : 영문 250 Pages
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한글목차

의료비 지불자 솔루션 시장 규모는 향후 수년간 급성장할 것으로 전망됩니다. 2029년에 CAGR은 10.0%를 나타낼 것으로 예측되고 725억 5,000만 달러로 성장할 전망입니다. 예측 기간 동안의 성장은 환자 중심 치료로의 전환, 원격의료 및 원격 치료의 증가, 데이터 보안에 대한 강조 강화, 가치 기반 지불 모델의 확산에 기인할 수 있습니다. 예측 기간의 주요 동향에는 재정적 투명성 및 비용 관리, 위험 계층화 및 인구 건강 관리, 데이터 상호운용성 및 교환, 가치 기반 진료 모델의 부상, AI 및 예측 분석 통합 등이 포함됩니다.

향후 5년간 10.0% 성장 전망은 이전 예측 대비 0.2% 소폭 하향 조정된 수치입니다. 이 같은 하향 조정은 주로 미국과 타국 간 관세 영향 때문입니다. 관세 장벽은 스위스와 에스토니아에서 원하는 블록체인 기반 청구 심사 플랫폼 및 예측 분석 모듈의 비용을 증가시켜 보험사의 보상 지연 기간을 연장하고 행정적 간접비를 상승시킴으로써 미국에 부정적 영향을 미칠 것으로 예상됩니다. 또한 상호 관세 부과와 무역 긴장 및 제한 강화로 인한 전 세계 경제 및 무역에 대한 부정적 영향으로 그 효과가 더 광범위하게 나타날 것입니다.

예상되는 보험 가입자 증가가 의료비 지불자 솔루션 시장 성장을 촉진할 전망입니다. 보험 가입은 자격을 갖춘 신청자가 보험사에 등록하여 플랜 회원이 되는 과정입니다. 보험 시장에서 의료비 지불자 솔루션은 강력한 기업 핵심 행정 및 청구 관리 플랫폼 솔루션을 제공하여 다양한 사업 분야의 지불자 조직에 걸쳐 확장, 혁신 및 비용 절감을 촉진합니다. 예를 들어, 미국 메디케어 및 메디케이드 서비스 센터(CMS) 보고에 따르면, 2022년 헬스케어.gov 및 주 기반 마켓플레이스를 통해 건강보험에 가입한 미국인은 1,360만 명 이상으로, 이는 2021년 12월 15일까지 플랜에 등록한 인원의 92%를 차지합니다. 결과적으로 증가하는 보험 가입자 수는 의료비 지불자 솔루션 시장 수요를 촉진하고 있습니다.

목차

제1장 주요 요약

제2장 시장 특징

제3장 시장 동향과 전략

제4장 시장 : 금리, 인플레이션, 지정학, 무역전쟁과 관세, 그리고 코로나 및 회복이 시장에 미치는 영향을 포함한 거시경제 시나리오

제5장 세계의 성장 분석과 전략 분석 프레임워크

제6장 시장 세분화

제7장 지역별 및 국가별 분석

제8장 아시아태평양 시장

제9장 중국 시장

제10장 인도 시장

제11장 일본 시장

제12장 호주 시장

제13장 인도네시아 시장

제14장 한국 시장

제15장 서유럽 시장

제16장 영국 시장

제17장 독일 시장

제18장 프랑스 시장

제19장 이탈리아 시장

제20장 스페인 시장

제21장 동유럽 시장

제22장 러시아 시장

제23장 북미 시장

제24장 미국 시장

제25장 캐나다 시장

제26장 남미 시장

제27장 브라질 시장

제28장 중동 시장

제29장 아프리카 시장

제30장 경쟁 구도와 기업 프로파일

제31장 기타 주요 기업 및 혁신 기업

제32장 세계 시장 경쟁 벤치마킹과 대시보드

제33장 주요 인수합병(M&A)

제34장 최근 시장 동향

제35장 시장의 잠재력이 높은 국가, 부문, 전략

제36장 부록

HBR
영문 목차

영문목차

Healthcare payer solutions refer to tools and services designed to assist healthcare insurers, both public and private, as well as members in managing various aspects such as claims, member engagement, audits, medical records, and customer relations. These solutions play a crucial role in enhancing the overall performance of the healthcare system by improving care quality, reducing costs, increasing patient satisfaction, enhancing provider effectiveness, and leveraging unique competencies.

The main services offered by healthcare payer solutions include business process outsourcing services, information technology outsourcing services, and knowledge process outsourcing services. Business process outsourcing involves the transfer of one or more intensive business processes to a third party, who then takes responsibility for owning, administering, and maintaining the specified processes based on predetermined and quantifiable performance goals. Various applications within healthcare payer solutions include pharmacy audit and analysis systems, claims management services, fraud management services, computer-assisted coding (CAC) systems, member eligibility management services, provider network management services, payment management services, customer relationship management services, medical document management services, and general ledger and payroll management. These applications are utilized by both private and public provider end-users.

Note that the outlook for this market is being affected by rapid changes in trade relations and tariffs globally. The report will be updated prior to delivery to reflect the latest status, including revised forecasts and quantified impact analysis. The report's Recommendations and Conclusions sections will be updated to give strategies for entities dealing with the fast-moving international environment.

The sharp rise in U.S. tariffs and the resulting trade tensions in spring 2025 are having a significant impact on the healthcare sector, especially in the supply of essential medical devices, diagnostic equipment, and pharmaceuticals. Hospitals and healthcare providers are grappling with higher costs for imported surgical tools, imaging systems, and consumables like syringes and catheters, many of which have limited domestic substitutes. These escalating expenses are putting pressure on healthcare budgets, prompting some providers to delay equipment upgrades or pass increased costs on to patients. Furthermore, tariffs on raw materials and components are disrupting the manufacturing of vital drugs and devices, leading to supply chain delays. In response, the industry is adopting diversified sourcing strategies, expanding local production where feasible, and pushing for tariff exemptions on critical medical products.

The healthcare payer solutions market research report is one of a series of new reports from The Business Research Company that provides healthcare payer solutions market statistics, including healthcare payer solutions industry global market size, regional shares, competitors with healthcare payer solutions market share, detailed healthcare payer solutions market segments, market trends, and opportunities, and any further data you may need to thrive in the healthcare payer solutions industry. This healthcare payer solutions market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenarios of the industry.

The healthcare payer solution market size has grown strongly in recent years. It will grow from $45.34 billion in 2024 to $49.54 billion in 2025 at a compound annual growth rate (CAGR) of 9.3%. The growth in the historic period can be attributed to introduction of managed care, regulatory changes (hipaa, aca, etc), emphasis on data analytics, focus on member engagement and experience, transition towards interoperability.

The healthcare payer solution market size is expected to see rapid growth in the next few years. It will grow to $72.55 billion in 2029 at a compound annual growth rate (CAGR) of 10.0%. The growth in the forecast period can be attributed to shift towards patient-centric care, rise in telemedicine and remote care, increased emphasis on data security, value-based payment models. Major trends in the forecast period include financial transparency and cost management, risk stratification and population health management, data interoperability and exchange, rise of value-based care models, integration of AI and predictive analytics.

The forecast of 10.0% growth over the next five years reflects a slight reduction of 0.2% from the previous projection. This reduction is primarily due to the impact of tariffs between the US and other countries. Tariff barriers are expected to hamper the U.S. by increasing the cost of blockchain-based claims adjudication platforms and predictive analytics modules sourced from Switzerland and Estonia, thereby prolonging reimbursement delays and raising administrative overhead for insurers. The effect will also be felt more widely due to reciprocal tariffs and the negative effect on the global economy and trade due to increased trade tensions and restrictions.

The anticipated increase in insurance enrolments is poised to drive the growth of the healthcare payer solutions market. Insurance enrolment is the process by which a qualified applicant registers with the insurance provider and becomes a member of the plan. In the insurance market, healthcare payer solutions offer robust enterprise core administration and claim management platform solutions, fostering expansion, innovation, and cost savings for payer organizations across various business lines. For example, as reported by the Centers for Medicare & Medicaid Services in the USA, more than 13.6 million Americans enrolled in health insurance coverage for 2022 through HealthCare.gov and State-based Marketplaces, constituting 92% of those who registered for plans by December 15, 2021. Consequently, the increasing insurance enrolments are fueling the demand for the healthcare payer solutions market.

The upward trend in the aging population is expected to drive the growth of healthcare payer solutions in the future. An aging population denotes a demographic shift marked by a rising proportion of elderly individuals within a society over time. Healthcare payer solutions play a crucial role in helping the aging population streamline insurance processes, enhance patient care coordination, and improve financial management, addressing the specific needs and complexities associated with elderly healthcare. For example, the World Health Organization projected in October 2022 that by 2030, one out of every six individuals globally would be 60 years old or older. The proportion of the population aged 60 and over is expected to increase from 1 billion in 2020 to 1.4 billion during this period. Additionally, by 2050, the global population of individuals aged 60 and older is projected to double, reaching 2.1 billion. Therefore, the rising aging population is a driving force for the healthcare payer solutions market.

Product innovations emerge as a significant trend gaining traction in the healthcare payer solutions market. Major companies in this sector are dedicated to developing innovative solutions to fortify their business positions. For instance, in March 2022, IMAT Solutions, a US-based provider of innovative, real-time healthcare data management, and population health reporting solutions, introduced a new product addressing the gathering, aggregation, dissemination, and reporting of healthcare data. The new technologies and services from IMAT Solutions enable payers, statewide organizations, and Health Information Exchanges (HIEs) to leverage clustering and Software as a Service (SaaS)-based solutions, in addition to the company's new National Committee for Quality Assurance (NCQA) Data Aggregator Validation (DAV) designation.

Major companies operating in the healthcare payer solutions market are focusing on developing advanced solutions such as Payer Exchange to handle the escalating volumes of medical records and clinical data. Payer Exchange is a technological solution designed to facilitate clinical data exchange between healthcare providers and payers. For example, in June 2023, MRO Corp, a US-based clinical data exchange company, launched a Payer Exchange solution. This technology digitizes and automates the patient information request and fulfillment process, reducing manual burdens for hospital staff and improving workflows. Payer Exchange addresses the growing demand from payers for high-quality and timely clinical data, providing a secure, electronic connection for efficient communication between providers and payers. The solution emphasizes patient privacy, data quality, and risk adjustment premium accuracy.

In September 2022, Zelis, a US-based healthcare and financial technology growth company, acquired Payer Compass for an undisclosed amount. Through this acquisition, Zelis and Payer Compass aim to collaborate as a single organization to advance claims management solutions and make a substantial impact on the complexity and rising costs of healthcare. Payer Compass is a US-based provider in the healthcare industry offering reimbursement and claims pricing, administration, and processing solutions.

Major companies operating in the healthcare payer solution market include Cognizant Technical Solutions, Concentrix Corporation, Accenture plc, HCL Technologies Ltd., Xerox Corporation, UnitedHealth Group Inc., McKesson Corporation, HMS Holdings Corp., International Business Machines Corporation, Change Healthcare Inc., Wipro Limited, Infosys Limited, Tata Consultancy Services Limited, NTT Data Corporation, Genpact Limited, Mphasis Limited, Firstsource Solutions Limited, WNS Limited, IQVIA Inc., Omega Healthcare, R RCM Inc., Conduent Inc., EXL Service Holdings Inc., Cotiviti Holdings Inc., Cerner Corporation, Allscripts Healthcare Solutions Inc., Epic Systems Corporation, Athenahealth Inc., NextGen Healthcare Inc., eClinicalWorks LLC

North America was the largest region in the healthcare payer solution market in 2024. The regions covered in the healthcare payer solution market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa

The countries covered in the healthcare payer solution market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The healthcare payer solution market includes revenues earned by entities by providing product assessments, health plan member engagement, and payer analytics. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

Healthcare Payer Solution Global Market Report 2025 from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.

This report focuses on healthcare payer solution market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.

Reasons to Purchase

Where is the largest and fastest growing market for healthcare payer solution ? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward, including technological disruption, regulatory shifts, and changing consumer preferences? The healthcare payer solution market global report from the Business Research Company answers all these questions and many more.

The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.

The forecasts are made after considering the major factors currently impacting the market. These include the technological advancements such as AI and automation, Russia-Ukraine war, trade tariffs (government-imposed import/export duties), elevated inflation and interest rates.

Scope

Table of Contents

1. Executive Summary

2. Healthcare Payer Solution Market Characteristics

3. Healthcare Payer Solution Market Trends And Strategies

4. Healthcare Payer Solution Market - Macro Economic Scenario Including The Impact Of Interest Rates, Inflation, Geopolitics, Trade Wars and Tariffs, And Covid And Recovery On The Market

5. Global Healthcare Payer Solution Growth Analysis And Strategic Analysis Framework

6. Healthcare Payer Solution Market Segmentation

7. Healthcare Payer Solution Market Regional And Country Analysis

8. Asia-Pacific Healthcare Payer Solution Market

9. China Healthcare Payer Solution Market

10. India Healthcare Payer Solution Market

11. Japan Healthcare Payer Solution Market

12. Australia Healthcare Payer Solution Market

13. Indonesia Healthcare Payer Solution Market

14. South Korea Healthcare Payer Solution Market

15. Western Europe Healthcare Payer Solution Market

16. UK Healthcare Payer Solution Market

17. Germany Healthcare Payer Solution Market

18. France Healthcare Payer Solution Market

19. Italy Healthcare Payer Solution Market

20. Spain Healthcare Payer Solution Market

21. Eastern Europe Healthcare Payer Solution Market

22. Russia Healthcare Payer Solution Market

23. North America Healthcare Payer Solution Market

24. USA Healthcare Payer Solution Market

25. Canada Healthcare Payer Solution Market

26. South America Healthcare Payer Solution Market

27. Brazil Healthcare Payer Solution Market

28. Middle East Healthcare Payer Solution Market

29. Africa Healthcare Payer Solution Market

30. Healthcare Payer Solution Market Competitive Landscape And Company Profiles

31. Healthcare Payer Solution Market Other Major And Innovative Companies

32. Global Healthcare Payer Solution Market Competitive Benchmarking And Dashboard

33. Key Mergers And Acquisitions In The Healthcare Payer Solution Market

34. Recent Developments In The Healthcare Payer Solution Market

35. Healthcare Payer Solution Market High Potential Countries, Segments and Strategies

36. Appendix

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