ヘルスケアペイヤーサービス（医療費支払者）の世界市場：2023～2030年

世界のヘルスケアペイヤーサービス（医療費支払者）の市場規模は、2023～2030年の予測期間中にCAGR 7.8％で成長すると予測されています。同市場の成長の背景には、費用対効果の高い業務に対するニーズの高まりと、高度なサプライチェーン管理（SCM）手法に対する需要の高まりがあり、ヘルスケアサプライチェーンBPOサービスの全体的なコストを最小限に抑えることが、予測期間中の市場成長を後押しするとみられます。さらに、PPACAを契機とした医療保険加入、連邦政府の医療義務化の高まり、慢性疾患の罹患率の上昇、医療不正事例の増加が市場成長を促進する要因となっています。2023年6月、Centers for Medicare & Medicaid Services (CMS) はMedicareの最新加入者数を発表しました。2023年3月現在、Medicareに加入している人は6,574万8,297人で、9月の前回報告から約10万人増加しました。そのうち3,394万8,778人がOriginal Medicareに加入しています。3,179万9,519人がMedicare Advantageまたはその他の医療保険に加入しています。これには、処方箋薬の適用がある場合とない場合のMedicare Advantageプランへの加入が含まれます。Medicare Part Dへの加入者は5,159万1,776人で、これには単独の処方薬プランと処方薬保険を提供するMedicare Advantageプランへの加入が含まれます。加えて、慢性疾患の増加が健康保険への加入をさらに促進し、ヘルスケアペイヤーサービスの導入につながり、市場の成長を後押ししています。国際糖尿病連合（International Diabetic Federation 2021）によると、20～79歳の約5億3,700万人が糖尿病に罹患しています。糖尿病は670万人以上の死亡の原因となっています。2030年までに、糖尿病患者全体の数は6億4,300万人に達し、2045年までに7億8,300万人に達すると予想されています。さらに、Globocan 2020によれば、新たに1,930万人が発症し、1,000万人ががんで死亡すると推定されています。このような慢性疾患の大きな負担は、医療用医薬品の採用拡大につながり、市場の成長を大きく促進します。

セグメント別展望

民間ペイヤーが世界のヘルスケアペイヤーサービス市場で大きなシェアを占めると予想されます。

最終用途の中でも、民間ペイヤーのサブセグメントが予測期間中に成長すると予想されます。このセグメントを牽引しているのは、ヘルスケアペイヤー分野への民間投資の増加と、ヘルスケア産業への民間投資を促進する政府支援の拡大です。National Health（NIH）Interview Survey 2022によると、18～64歳の成人のうち12.2%が無保険、22.0%が公的保険、67.8%が民間医療保険に加入しています。民間保険に加入しているのは18～64歳の成人が最も多く（67.8％）、次いで0～17歳の子供（54.3％）、65歳以上の成人（45.7％）でした。

地域別の展望

世界のヘルスケアペイヤーサービス市場は、北米（米国、カナダ）、欧州（英国、イタリア、スペイン、ドイツ、フランス、その他の欧州）、アジア太平洋（インド、中国、日本、韓国、その他のアジア太平洋）、その他の地域（中東・アフリカ、ラテンアメリカ）を含む地域別にさらに細分化されています。なかでもアジア太平洋は、ヘルスケアペイヤーサービスに対する需要の高まり、高齢者人口の増加、健康保険導入の増加、医療不正の増加、医療費の増加などにより、予測期間中に成長すると予測されています。

北米地域は世界のヘルスケアペイヤーサービス市場において著しいCAGRで成長する見込み

北米は、高度なヘルスケアシステムの存在とともに、ヘルスケア政策の採用が増加していることから、同市場において大きなシェアを占めると予想されています。米国議会調査局（Congressional Research Service）が2023年2月に発表した記事「The US Health Care Coverage and Spending」（米国の医療保障と支出）によると、2021年にはほとんどの人が民間の医療保険に加入しているか、MedicareやMedicaidなどの政府プログラムに加入していました。米国の推定人口は3億2,700万人でした。そのほとんどが民間の医療保険に加入しているか、MedicareやMedicaid のような連邦政府のプログラムに加入していました。しかし、米国総人口の約8.6%はまだ無保険でした。無保険者を含む個人、医療保険者、連邦政府および州政府は、2021年に様々な種類の医療消費支出（HCE）に約4兆米ドルを費やし、これは全米の国内総生産（GDP）の17.4％を占めました。この地域におけるヘルスケア消費へのこのような巨額の投資は、保険請求へのヘルスケアペイヤーサービスの採用により、この地域におけるこの市場の成長を促進することにつながりました。

米国総人口に占める医療保険加入率（2021年）

目次

第1章 レポート概要

• 業界の現状分析と成長ポテンシャルの展望
• 調査方法とツール
• 市場内訳
  • セグメント別
  • 地域別

第2章 市場概要と洞察

• 調査範囲
• アナリストの洞察と現在の市場動向
  • 主な調査結果
  • 推奨事項
  • 結論

第3章 競合情勢

• 主要企業分析
• Accenture plc
• Dell Inc.
• Oracle Corp.
• Xerox Holdings Corp.

第4章 市場セグメンテーション

• ヘルスケアペイヤーサービスの世界市場：サービス別
  • BPOサービス
  • KPOサービス
  • ITOサービス
• ヘルスケアペイヤーサービスの世界市場：エンドユーザー別
  • 民間ペイヤー
  • 公的ペイヤー

第5章 地域別分析

• 北米
  • 米国
  • カナダ
• 欧州
  • 英国
  • ドイツ
  • イタリア
  • スペイン
  • フランス
  • その他の欧州
• アジア太平洋
  • 中国
  • インド
  • 日本
  • 韓国
  • その他のアジア太平洋
• その他の地域

第6章 企業プロファイル

• Allscripts Healthcare, LLC
• Cognizant Technology Solutions Corp.
• Concentric Corp.
• Conduent Inc.
• Conifer Health Solutions, LLC
• EXL Service Holdings, Inc.
• Firstsource Solutions Ltd.
• Genpact
• HCL Technologies Ltd.
• Hewlett-Packard
• Hinduja Global Solution Ltd.
• IBM Corp.
• Infosys Ltd.
• Inovalon
• IQVIA Inc.
• Mphasis Corp.
• NTT DATA GROUP Corp.
• OMH HealthEdge Holdings, LLC
• Parexel International Corp.
• R1 RCM, Inc.
• SAS Institute Inc.
• Tata consultancy services Ltd.
• UnitedHealth Group, Inc.
• Wipro Ltd.
• WNS（Holdings）Ltd.

LIST OF TABLES

• 1. GLOBAL HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY SERVICES, 2022-2030 ($ MILLION)
• 2. GLOBAL HEALTHCARE BPO SERVICES MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 3. GLOBAL HEALTHCARE KPO SERVICES MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 4. GLOBAL HEALTHCARE ITO SERVICES MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 5. GLOBAL HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022-2030 ($ MILLION)
• 6. GLOBAL HEALTHCARE PAYER SERVICES FOR PRIVATE PAYERS MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 7. GLOBAL HEALTHCARE PAYER SERVICES FOR PUBLIC PAYERS MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 8. GLOBAL HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 9. NORTH AMERICAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2022-2030 ($ MILLION)
• 10. NORTH AMERICAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY SERVICES, 2022-2030 ($ MILLION)
• 11. NORTH AMERICAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022-2030 ($ MILLION)
• 12. EUROPEAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2022-2030 ($ MILLION)
• 13. EUROPEAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY SERVICES, 2022-2030 ($ MILLION)
• 14. EUROPEAN HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022-2030 ($ MILLION)
• 15. ASIA-PACIFIC HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY COUNTRY, 2022-2030 ($ MILLION)
• 16. ASIA-PACIFIC HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY SERVICES, 2022-2030 ($ MILLION)
• 17. ASIA-PACIFIC HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022-2030 ($ MILLION)
• 18. REST OF THE WORLD HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY REGION, 2022-2030 ($ MILLION)
• 19. REST OF THE WORLD HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY SERVICES, 2022-2030 ($ MILLION)
• 20. REST OF THE WORLD HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022-2030 ($ MILLION)

LIST OF FIGURES

• 1. GLOBAL HEALTHCARE PAYER SERVICES MARKET SHARE BY SERVICES, 2022 VS 2030 (%)
• 2. GLOBAL HEALTHCARE BPO SERVICES MARKET SHARE BY MATERIAL, 2022 VS 2030 (%)
• 3. GLOBAL HEALTHCARE KPO SERVICES MARKET SHARE BY REGION, 2022 VS 2030 (%)
• 4. GLOBAL HEALTHCARE ITO SERVICES MARKET SHARE BY REGION, 2022 VS 2030 (%)
• 5. GLOBAL HEALTHCARE PAYER SERVICES MARKET RESEARCH AND ANALYSIS BY END-USE, 2022 VS 2030 (%)
• 6. GLOBAL HEALTHCARE PAYER SERVICES FOR PRIVATE PAYERS MARKET SHARE BY REGION, 2022 VS 2030 (%)
• 7. GLOBAL HEALTHCARE PAYER SERVICES FOR PUBLIC PAYERS MARKET SHARE BY REGION, 2022 VS 2030 (%)
• 8. GLOBAL HEALTHCARE PAYER SERVICES MARKET SHARE BY REGION, 2022 VS 2030 (%)
• 9. US HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 10. CANADA HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 11. UK HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 12. FRANCE HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 13. GERMANY HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 14. ITALY HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 15. SPAIN HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 16. REST OF EUROPE HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 17. INDIA HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 18. CHINA HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 19. JAPAN HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 20. SOUTH KOREA HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 21. REST OF ASIA-PACIFIC HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)
• 22. REST OF THE WORLD HEALTHCARE PAYER SERVICES MARKET SIZE, 2022-2030 ($ MILLION)

Global Healthcare Payer Services Market Size, Share & Trends Analysis Report by Services (Business Process Outsourcing (BPO) Services, Knowledge Process Outsourcing (KPO) Services, and Information Technology Outsourcing (ITO) Services), and by End-Use (Private Payers and Public Payers), Forecast Period (2023-2030)

The global healthcare payer services market is anticipated to grow at a CAGR of 7.8% during the forecast period (2023-2030). The growth of this market is attributed to the rising need for cost-effective operations and the growth in demand for advanced supply chain management (SCM) practices, minimizing the overall cost of healthcare supply chain BPO services is likely to boost market growth during the forecast period. Moreover, health insurance enrollments triggered by PPACA, rising federal healthcare mandates, rising incidences of chronic diseases, and growing cases of healthcare fraud are factors driving market growth. In June 2023, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare. As of March 2023, there were 65,748,297 people are enrolled in Medicare, an increase of almost 100,000 since the last report in September. Of those, 33,948,778 were enrolled in Original Medicare. There were 31,799,519 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage. There were 51,591,776 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage. In addition, the rising chronic diseases further bolster way for health insurance, leading to the adoption of healthcare payer services and fueling the market growth. According to the International Diabetic Federation 2021, around 537 million persons aged 20 to 79 affected by diabetes. Diabetes was responsible for over 6.7 million deaths. By 2030, the overall number of diabetics is expected to reach 643 million, and by 2045, it will reach 783 million. Additionally, according to Globocan 2020, estimated 19.3 million new cases, and 10 million cancer deaths. Such a huge burden of chronic diseases will lead to increased adoption of ethical medication, driving the market growth significantly.

Segmental Outlook

The global healthcare payer services market is segmented based on technology, and end-use. Based on the technology, the market is sub-segmented into BPO services, KPO services, and ITO services. Further, based on end-use, the market is sub-segmented into private payers, and public payers. Among the end-use, the private payers sub-segment is anticipated to hold a largest market share during the forecast period. The large share of this segment is credited to the lower costs, higher efficiency, and ability to focus on essential business operations provided by BPO services. This greatly attributes to the fact that BPO services offer administration in important administrative domains.

The Private Payers Sub-Segment is Anticipated to Hold a Considerable Share of the Global Healthcare Payer Services Market

Among the end-use, private payers sub-segments expected to grow over the forecast period. The segment is driven by the owing to the increasing private investment in the healthcare payer vertical and growing government support to promote private investment in the healthcare industry. According to the National Health (NIH) Interview Survey 2022, among adults aged 18-64 years, 12.2% were uninsured, 22.0% had public coverage, and 67.8% had private health insurance coverage. Adults aged 18-64 were the most likely to have private coverage (67.8%), followed by children aged 0-17 years (54.3%) and adults aged 65 and over (45.7%).

Regional Outlook

The global healthcare payer services market is further segmented based on geography including North America (the US, and Canada), Europe (UK, Italy, Spain, Germany, France, and the Rest of Europe), Asia-Pacific (India, China, Japan, South Korea, and Rest of Asia), and the Rest of the World (the Middle East & Africa, and Latin America). Among these, the Asia-Pacific region is anticipated to grow over the forecast period, owing to the growing demand for healthcare payer services, increasing geriatric population, rising adoption of health insurance, the rising healthcare frauds, and the rising healthcare expenditure.

The North America Region is Expected to Grow at a Significant CAGR in the Global Healthcare Payer Services Market

North America is expected to hold a prominent share in the market, owing to the rising adoption of healthcare policies along with the presence of sophisticated healthcare system in the region. According to the article published by the Congressional Research Service, titled 'The US Health Care Coverage and Spending,' updated in February 2023, most people had private health insurance or were covered by a government program such as Medicare or Medicaid in 2021. The US had an estimated population of 327 million individuals. Most of those individuals had private health insurance or were covered under a federal program such as medicare or medicaid. However, about 8.6% of the total US population was still uninsured. Individuals including those who were uninsured, health insurers, and federal and state governments spent approximately $4.0 trillion on various types of health consumption expenditures (HCE) in 2021, which accounted for 17.4% of the nation's gross domestic product (GDP). Such a huge investment in healthcare consumption in this region led to driving the growth of this market in this region owing to the adoption of healthcare payer services to claim insurance.

Health Insurance Coverage as a Percentage of Total US Population, 2021

Source: US Health Care Coverage and Spending

Market Players Outlook

The major companies serving the global healthcare payer services market include Accenture plc, Dell Inc., Oracle Corp., Xerox Holdings Corp., HCL Technologies Ltd., Hewlett-Packard, IBM Corp., Infosys Ltd., and others. The market players are considerably contributing to the market growth by the adoption of various strategies including mergers and acquisitions, partnerships, collaborations, funding, and new product launches, to stay competitive in the market. For instance, in January 2023, Elevance Health acquired the Blue Cross and Blue Shield of Louisiana (BCBSLA), with the payers aiming to improve care access, quality, and affordability for Louisiana members.

The Report Covers:

• Market value data analysis of 2022 and forecast to 2030.
• Annualized market revenues ($ million) for each market segment.
• Country-wise analysis of major geographical regions.
• Key companies operating in the global healthcare payer services market. Based on the availability of data, information related to new product launches, and relevant news is also available in the report.
• Analysis of business strategies by identifying the key market segments positioned for strong growth in the future.
• Analysis of market-entry and market expansion strategies.
• Competitive strategies by identifying 'who-stands-where' in the market.

Table of Contents

1. Report Summary

• Current Industry Analysis and Growth Potential Outlook
• 1.1. Research Methods and Tools
• 1.2. Market Breakdown
  • 1.2.1. By Segments
  • 1.2.2. By Region

2. Market Overview and Insights

• 2.1. Scope of the Report
• 2.2. Analyst Insight & Current Market Trends
  • 2.2.1. Key Findings
  • 2.2.2. Recommendations
  • 2.2.3. Conclusion

3. Competitive Landscape

• 3.1. Key Company Analysis
• 3.2. Accenture plc
  • 3.2.1. Overview
  • 3.2.2. Financial Analysis
  • 3.2.3. SWOT Analysis
  • 3.2.4. Recent Developments
• 3.3. Dell Inc.
  • 3.3.1. Overview
  • 3.3.2. Financial Analysis
  • 3.3.3. SWOT Analysis
  • 3.3.4. Recent Developments
• 3.4. Oracle Corp.
  • 3.4.1. Overview
  • 3.4.2. Financial Analysis
  • 3.4.3. SWOT Analysis
  • 3.4.4. Recent Developments
• 3.5. Xerox Holdings Corp.
  • 3.5.1. Overview
  • 3.5.2. Financial Analysis
  • 3.5.3. SWOT Analysis
  • 3.5.4. Recent Developments
• 3.6. Key Strategy Analysis

4. Market Segmentation

• 4.1. Global Healthcare Payer Services Market by Services
  • 4.1.1. Business Process Outsourcing (BPO) Services
  • 4.1.2. Knowledge Process Outsourcing (KPO) Services
  • 4.1.3. Information Technology Outsourcing (ITO) Services
• 4.2. Global Healthcare Payer Services Market by End-Use
  • 4.2.1. Private Payers
  • 4.2.2. Public Payers

5. Regional Analysis

• 5.1. North America
  • 5.1.1. United States
  • 5.1.2. Canada
• 5.2. Europe
  • 5.2.1. UK
  • 5.2.2. Germany
  • 5.2.3. Italy
  • 5.2.4. Spain
  • 5.2.5. France
  • 5.2.6. Rest of Europe
• 5.3. Asia-Pacific
  • 5.3.1. China
  • 5.3.2. India
  • 5.3.3. Japan
  • 5.3.4. South Korea
  • 5.3.5. Rest of Asia-Pacific
• 5.4. Rest of the World

6. Company Profiles

• 6.1. Allscripts Healthcare, LLC
• 6.2. Cognizant Technology Solutions Corp.
• 6.3. Concentric Corp.
• 6.4. Conduent Inc.
• 6.5. Conifer Health Solutions, LLC
• 6.6. EXL Service Holdings, Inc.
• 6.7. Firstsource Solutions Ltd.
• 6.8. Genpact
• 6.9. HCL Technologies Ltd.
• 6.10. Hewlett-Packard
• 6.11. Hinduja Global Solution Ltd.
• 6.12. IBM Corp.
• 6.13. Infosys Ltd.
• 6.14. Inovalon
• 6.15. IQVIA Inc.
• 6.16. Mphasis Corp.
• 6.17. NTT DATA GROUP Corp.
• 6.18. OMH HealthEdge Holdings, LLC
• 6.19. Parexel International Corp.
• 6.20. R1 RCM, Inc.
• 6.21. SAS Institute Inc.
• 6.22. Tata consultancy services Ltd.
• 6.23. UnitedHealth Group, Inc.
• 6.24. Wipro Ltd.
• 6.25. WNS (Holdings) Ltd.