Healthcare Reimbursement Market Size, Share & Trends Analysis Report By Claim (Fully Paid, Underpaid), By Payers (Private, Public), By Service Provider (Hospitals, Diagnostic Labs), And Segment Forecasts, 2018 - 2026

Published: Dec, 2018 | Pages: 120 | Publisher: Grand View Research
Industry: Medical Devices | Report Format: Electronic (PDF)

The global healthcare reimbursement market size is expected to reach USD 20.45 trillion by 2026, according to a new report by Grand View Research, Inc., exhibiting a CAGR of 19.0% during the forecast period. Supportive government initiatives along with rising cost of prescription medicines are likely to work in favor of the market.

The U.S. Affordable Care Act focuses on controlling and minimizing costs of healthcare. The law supports innovative methods to deliver medical care to reduce healthcare costs and makes affordable health insurance available to more people. Since the Obamacare came into effect in 2014, the number of uninsured children under the age of 18 in the U.S. reduced to 5.0% in 2015 as compared to 9% in 2008.

In addition, the Centre for Medicare & Medicaid Services is working towards delivery of reliable high-quality care, endorsement of efficient results in healthcare system, and making health insurance affordable for millions of Americans who are seeking and getting coverage. The Medicaid spending in the U.S. grew by 3.9% in 2016 or 17.0% of the total National Health Expenditure. And Medicare spending grew by 3.6% in 2016 or 20.0% of the total National Health Expenditure.

The underpaid segment is anticipated to dominate the market through 2026 owing to growing cases of frauds against government healthcare programs and increasing use of healthcare services that are not medically required. There have been several cases where businesses and individuals have defrauded federal and state government healthcare programs by submitting false claims for healthcare services, treatment, pharmaceutical, and medical devices that were never rendered.

Also, the rivalry among healthcare providers and rising pressure from commercial and public payers to reduce costs as well as to improve care are shifting their focus towards value-based care models from volume-based healthcare models.

Further key findings from the report suggest:

•  Underpaid emerged as the largest segment in 2017 owing to increasing number of insurance plans that do not cover full reimbursement

•  On the basis of payers, private players accounted for the leading share in the market in 2017 owing to presence of a large number of private players

•  North America dominated the market in 2017. A raft of insurance players and strong reimbursement framework are facilitating the dominance of the region

•  The market in Asia Pacific is projected to witness rapid growth during the forecast period owing to rising penetration of insurance services in rural and urban areas

•  Some of the market players are UnitedHealth Group, Allianz, Aviva, Aetna, Nippon Life Insurance, CVS Health, WellCare Health Plans, BNP Paribas, The Blue Cross Blue Shield Association, and AgileHealthInsurance.

 Table of Contents

Chapter 1 Report Scope
                     1.1 Segment Market Scope
                     1.2 Regional Scope
                     1.3 Estimates and Forecast Timeline
Chapter 2 Methodology
                     2.1 Research Methodology
                         2.1.1 Information procurement
                     2.2 Information or Data Analysis
                     2.3 Market Formulation & Validation
                     2.4 Region Wise Market Calculation
                         2.4.1 Region Wise Market: Base Estimates
                         2.4.2 Global Market: CAGR Calculation
                     2.5 Region Based Segment Share Calculation
                     2.6 Model Details
                         2.6.1 Commodity flow analysis (Model 1)
                         2.6.2 Volume price analysis (model 2)
                     2.7 List of Secondary Sources
                     2.8 List of Primary Sources
                     2.9 List of Abbreviations
Chapter 3 Objectives
                     3.1 Objective - 1: Understanding the market dynamics
                     3.2 Objective - 2: Understanding the market estimates and forecasts
                     3.3 Objective - 3: Understanding the attributes such as strategy framework, competitor categorization
                     3.4 Objective - 4: Understanding the key end-users, technological, application and product scopes
Chapter 4 Executive Summary
Chapter 5 Market Definition
Chapter 6 Industry Outlook
                     6.1 Market Segmentation
                     6.2 Business Segment Trends
                         6.2.1 Product business analysis
                         6.2.2 regional business analysis
                     6.3 Market Variable Analysis
                         6.3.1 Market driver analysis
                             6.3.1.1 Increasing cost of healthcare
                             6.3.1.2 Supportive Government Programs
                         6.3.2 Market restraint analysis
                             6.3.2.1 Complex Framework
                     6.4 Business Environment Analysis tools
                         6.4.1 SWOT Analysis, by PEST
                         6.4.2 Porter's five forces analysis
                         6.4.3 Industry Analysis - Ansoff Matrix
Chapter 7 Competitive & Vendor Landscape
                     7.1 Participant Categorization
                         7.1.1 Innovators
                     7.2 Strategy Mapping
                         7.2.1 Acquisition:
                         7.2.2 Collaboration:
                         7.2.3 New Product Launch:
                         7.2.4 Expansion:
                         7.2.5 Partnerships:
Chapter 8 Healthcare Reimbursement Market: Claim Estimates & Trend Analysis 
                     8.1 Healthcare reimbursement Market: Claim Movement Analysis
                     8.2 Fully Paid
                         8.2.1 Fully Paid market estimates and forecasts, 2014 - 2026 (USD Billion)
                     8.3 Underpaid
                         8.3.1 Underpaid market estimates and forecasts, 2014 - 2026 (USD Billion)
Chapter 9 Healthcare Reimbursement Market: Payer Estimates & Trend Analysis 
                     9.1 Healthcare reimbursement Market: Payer Movement Analysis
                     9.2 Private Payers
                         9.2.1 Private payers market estimates and forecasts, 2014 - 2026 (USD Billion)
                     9.3 Public Payers
                         9.3.1 Public payers market estimates and forecasts, 2014 - 2026 (USD Billion)
Chapter 10 Healthcare Reimbursement Market: Service Provider Estimates & Trend Analysis 
                     10.1 Healthcare reimbursement Market: Service Provider Movement Analysis
                     10.2 Physician office
                         10.2.1 Physician office market estimates and forecasts, 2014 - 2026 (USD Billion)
                     10.3 Hospitals
                         10.3.1 Hospitals market estimates and forecasts, 2014 - 2026 (USD Billion)
                     10.4 Diagnostic Laboratories
                         10.4.1 Diagnostic Laboratories market estimates and forecasts, 2014 - 2026 (USD Billion)
                     10.5 Others
                         10.5.1 Others market estimates and forecasts, 2014 - 2026 (USD Billion)
Chapter 11 Regional Outlook
                     11.1 Healthcare reimbursement Market: Regional Movement Analysis
                     11.2 North America
                         11.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.2.2 U.S.
                             11.2.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.2.3 Canada
                             11.2.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                     11.3 Europe
                         11.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.3.2 U.K.
                             11.3.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.3.3 Germany
                             11.3.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.3.4 RoE
                             11.3.4.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                     11.4 Asia Pacific
                         11.4.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.4.2 Japan
                             11.4.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.4.3 China
                             11.4.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.4.4 Rest of Asia Pacific
                             11.4.4.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                     11.5 Latin America
                         11.5.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.5.2 Brazil
                             11.5.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.5.3 Mexico
                             11.5.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.5.4 Rest of Latin america
                             11.5.4.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                     11.6 MEA
                         11.6.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.6.2 South Africa
                             11.6.2.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.6.3 Saudi Arabia
                             11.6.3.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
                         11.6.4 RoMEA
                             11.6.4.1 Market estimates and forecasts, 2014 - 2026 (USD Billion)
Chapter 12 Company Profiles
                     12.1 Strategic Framework
                     12.2 Company Profiles
                         12.2.1 Unitedhealth group
                             12.2.1.1 Company overview
                             12.2.1.2 Financial performance
                             12.2.1.3 service benchmarking
                             12.2.1.4 Strategic initiatives
                         12.2.2 Aviva
                             12.2.2.1 Company overview
                             12.2.2.2 Financial performance
                             12.2.2.3 Service benchmarking
                         12.2.3 Allianz Group
                             12.2.3.1 Company overview
                             12.2.3.2 Financial performance
                             12.2.3.3 Service benchmarking
                             12.2.3.4 Strategic initiatives
                         12.2.4 CVS Health
                             12.2.4.1 Company overview
                             12.2.4.2 Financial performance
                             12.2.4.3 Service benchmarking
                             12.2.4.4 Strategic initiatives
                         12.2.5 BNP PAribas
                             12.2.5.1 Company overview
                             12.2.5.2 Financial performance
                             12.2.5.3 Service benchmarking
                         12.2.6 Aetna
                             12.2.6.1 Company overview
                             12.2.6.2 Financial performance
                             12.2.6.3 Service benchmarking
                         12.2.7 Nippon Life Insurance
                             12.2.7.1 Company overview
                             12.2.7.2 Financial performance
                             12.2.7.3 Service benchmarking
                             12.2.7.4 Strategic initiatives
                         12.2.8 Wellcare Health Plans
                             12.2.8.1 Company overview
                             12.2.8.2 Financial performance
                             12.2.8.3 Service benchmarking
                             12.2.8.4 Strategic Initiatives
                         12.2.9 AgileHealthInsurance
                             12.2.9.1 Company overview
                             12.2.9.2 Service benchmarking
                             12.2.9.3 Strategic initiatives
                         12.2.10 The Blue Cross Blue Shield Association
                             12.2.10.1 Company overview
                             12.2.10.2 Service benchmarking
                             12.2.10.3 Strategic initiatives
Chapter 13 KOL Commentary
                     13.1 Key Insights
                     13.2 KOL Views
Chapter 14 Recommendations

List of Tables

Table 1 List of secondary sources
Table 2 List of Abbreviation
Table 3 Leading market players anticipated to witness highest growth
Table 4 Global Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 5 Global Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 6 Global Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 7 Global Healthcare Reimbursement Market Estimates & Forecasts, by Region, 2014 - 2026 (USD Billion)
Table 8 North America Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 9 North America Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 10 North America Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion) 
Table 11 U.S. Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 12 U.S. Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 13 U.S. Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 14 Canada Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 15 Canada Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 16 Canada Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 17 Europe Healthcare Reimbursement Market Estimates & Forecasts, by Country 2014 - 2026 (USD Billion)
Table 18 Europe Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 19 Europe Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 20 Europe Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 21 U.K. Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 22 U.K. Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 23 U.K. Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 24 Germany Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 25 Germany Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 26 Germany Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion) 
Table 27 Asia Pacific Healthcare Reimbursement Market Estimates & Forecasts, by Country 2014 - 2026 (USD Billion)
Table 28 Asia Pacific Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 29 Asia Pacific Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 30 Asia Pacific Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion) 
Table 31 Japan Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 32 Japan Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 33 Japan Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 34 China Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 35 China Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 36 China Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 37 Latin America Healthcare Reimbursement Market Estimates & Forecasts, by Country 2014 - 2026 (USD Billion)
Table 38 Latin America Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 39 Latin America Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 40 Latin America Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion) 
Table 41 Mexico Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 42 Mexico Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 43 Mexico Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 44 Brazil Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 45 Brazil Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 46 Brazil Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 47 MEA Healthcare Reimbursement Market Estimates & Forecasts, by Country 2014 - 2026 (USD Billion)
Table 48 MEA Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 49 MEA Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 50 MEA Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)
Table 51 South Africa Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 52 South Africa Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 53 South Africa Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion) 
Table 54 Saudi Arabia Healthcare Reimbursement Market Estimates & Forecasts, by Claim 2014 - 2026 (USD Billion)
Table 55 Saudi Arabia Healthcare Reimbursement Market Estimates & Forecasts, by Payer 2014 - 2026 (USD Billion)
Table 56 Saudi Arabia Healthcare Reimbursement Market Estimates & Forecasts, by Service Provider 2014 - 2026 (USD Billion)

List of Figures

Fig. 1 Market research process
Fig. 2 Information procurement
Fig. 3 Primary research pattern
Fig. 4 Market research approaches
Fig. 5 Value chain based sizing & forecasting
Fig. 6 QFD modelling for market share assessment
Fig. 7 Market formulation & validation
Fig. 8 Healthcare reimbursement market segmentation
Fig. 9 Market driver relevance analysis (Current & future impact)
Fig. 10 Market restraint relevance analysis (Current & future impact)
Fig. 11 SWOT analysis, by factor (political & legal, economic and technological)
Fig. 12 Porter's five forces analysis
Fig. 13 Ansoff matrix analysis
Fig. 14 Heat map analysis
Fig. 15 Strategy mapping
Fig. 16 Healthcare reimbursement market claim outlook: Key takeaways
Fig. 17 Healthcare reimbursement market: Claim movement analysis
Fig. 18 Fully paid market , 2014 - 2026 (USD Billion)
Fig. 19 Underpaid market , 2014 - 2026 (USD Billion)
Fig. 20 Healthcare reimbursement market payer outlook: Key takeaways
Fig. 21 Healthcare reimbursement market: Payer movement analysis
Fig. 22 Private payers market, 2014 - 2026 (USD Billion)
Fig. 23 Public payers market, 2014 - 2026 (USD Billion)
Fig. 24 Healthcare reimbursement market service provider outlook: Key takeaways
Fig. 25 Healthcare reimbursement market: service provider movement analysis
Fig. 26 Physician office market, 2014 - 2026 (USD Billion)
Fig. 27 Hospitals market, 2014 - 2026 (USD Billion)
Fig. 28 Diagnostic laboratories market, 2014 - 2026 (USD Billion)
Fig. 29 Others market, 2014 - 2026 (USD Billion)
Fig. 30 Regional market place: Key takeaways
Fig. 31 Healthcare reimbursement market: Regional movement analysis
Fig. 32 North America healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 33 U.S. healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 34 Canada healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 35 Europe healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 36 U.K. healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 37 Germany healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 38 RoE healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 39 Asia Pacific healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 40 Japan healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 41 China healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 42 Rest of Asia Pacific healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 43 Latin America healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 44 Brazil healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 45 Mexico healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 46 Rest of Latin America healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 47 Mexico healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 48 South Africa healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 49 Saudi Arabia healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 50 RoMEA healthcare reimbursement market, 2014 - 2026 (USD Billion)
Fig. 51 Strategy framework
Fig. 52 Market participant categorization