ヘルスケア償還市場の2032年までの予測： 請求別、支払者別、サービスプロバイダー別、地域別の世界分析

Stratistics MRCによると、世界のヘルスケア償還市場は2025年に315億9,000万米ドルを占め、2032年には1,151億9,000万米ドルに達すると予測されています。

診療所、病院、医師などのヘルスケアプロバイダーが、保険会社、メディケアやメディケイドのような政府のイニシアチブ、または患者から直接サービスに対する支払いを受けるプロセスは、ヘルスケア償還として知られています。このシステムにより、ヘルスケア専門家は、標準的な検査から複雑な外科手術に至るまで、提供したサービスに対する支払いを受けることが保証されます。キャピテーション、バリュー・ベース・ケア、バンドル・ペイメント、フィー・フォー・サービスなど、さまざまな診療報酬モデルは、医療提供者のインセンティブ、コスト管理、医療の質にさまざまな影響を与えます。

米国医師会（AMA）によれば、米国の医療支出は2023年に7.5％増加し、4兆9,000億米ドル、国民一人当たり1万4,570米ドルに達します。この伸び率は2022年の4.6％増を著しく上回り、COVID-19パンデミックによる2020年の10.4％増を除けば、2003年以降で最も高い伸び率です。

慢性疾患有病率の増加

世界的に、糖尿病、がん、心臓病などの慢性疾患は、死亡や身体障害の原因の上位にランクされています。世界保健機関（WHO）によれば、非伝染性疾患は世界全体の死亡原因の約74％を占めています。さらに、これらの病気は、継続的なケア、医師による定期的な診察、処方薬、時には入院が必要となることが多いです。患者やヘルスケアシステムが長期的な医療費をコントロールできるよう、包括的かつ継続的な償還制度の必要性が高まっています。

複雑でバラバラな診療報酬の枠組み

支払主体（民間か公的か）、サービスの種類、人口統計によって、ヘルスケア償還政策は国家間、さらには国家内でも大きく異なります。米国ではメディケア、メディケイド、民間保険会社はそれぞれ異なる規制を受けています。さらに、管理上の非効率、請求ミス、患者と医療者間の誤解は、この一貫性の欠如によって引き起こされます。複雑な文書化要件、コーディング仕様、承認プロセスは、支払遅延の原因となり、プロバイダーが特定の償還プログラムに参加することを躊躇させています。

デジタルヘルスと遠隔医療サービスの開発

特にCOVID-19パンデミックの最中とその後に、遠隔医療が急速に普及したため、診療報酬が伸びる可能性が大きいです。政府や保険会社は、モバイル健康アプリ、遠隔モニタリング、バーチャル診察をますます償還スキームに組み込んでいます。さらに、米国病院協会によれば、遠隔医療利用率はパンデミック前の38倍の水準で安定しています。このようなサービスの保険適用を拡大することで、医療格差を是正し、地方でのアクセスを強化し、制度的負担を軽減することで、長期的には診療報酬市場を成長させることができます。

サイバーセキュリティとデータ漏洩のリスク

デジタルプラットフォームは、ヘルスケアシステムにおける請求ワークフローの処理、患者の個人情報の保管、診療報酬請求の処理に不可欠です。このような依存関係のため、この業界はサイバー攻撃に対して特に脆弱です。たった一度のデータ侵害で、業務が停止し、何千もの患者記録が危険にさらされる可能性があります。さらに、米国保健社会福祉省（HHS）によると、医療データ侵害の報告件数は着実に増加しており、2023年だけでも700件以上の侵害が1億3,300万人以上に影響を及ぼしています。このような事態は社会的信用を損ない、セキュリティとコンプライアンスにかかる費用を増大させます。

COVID-19の影響：

COVID-19の大流行は、世界の償還モデルを大きく変え、規制の柔軟化を促し、デジタルヘルスサービスへの移行を加速させ、これらすべてがヘルスケア償還市場に影響を与えました。テレヘルス、遠隔モニタリング、在宅ケアは、以前は保険償還が低かったり、除外されていたサービスであったが、医療制度が過重な負担となったため、政府や保険会社によって急速に保険適用となりました。バーチャル診察については、米国メディケア＆メディケイドサービスセンター（CMS）が実施したような一時的な政策変更により、支払いの平準化と請求コードの拡大が可能になりました。さらに、これらの変更は当初は緊急措置であったにもかかわらず、デジタルおよびバリューベースの償還は、現在ではヘルスケアのエコシステムに根付いています。

予測期間中、完全支払型セグメントが最大となる見込み

完全支払型セグメントは、予測期間中最大の市場シェアを占めると予想されます。全額支払請求とは、保険会社または医療提供者が医療保険制度の条件に従って処理し、全額を支払った医療報酬のことです。患者に未払い残高を残すことなく、ヘルスケア費用が効果的に決済されることから、この分野は市場のかなりの部分を占めています。さらに、完済請求は、特にヘルスケアコストの上昇とヘルスケアプランの複雑化に照らして、患者と医療提供者が医療サービスの支払いに必要な資金を確保していることを保証するものです。

予測期間中、CAGRが最も高くなると予想されるのは医院部門です。

予測期間中、最も高い成長率を示すと予測されるのは医院部門です。人口の高齢化、慢性疾患の罹患率の増加、外来診療のニーズの増加が、この成長を促進する要因の一部です。ヘルスケアシステムにおける医院の役割の増大は、手頃な料金で医療を提供し、慢性疾患の管理において重要な役割を果たすことができる結果です。さらに、遠隔医療の開発とバリュー・ベース・ケア・モデルへの移行が、医院が提供するサービスへの需要を高めています。ヘルスケア償還の観点から、この市場セグメントは最も速い速度で成長すると予想されます。

最大のシェアを占める地域

予測期間中、北米地域が最大の市場シェアを占めると予想されます。世界市場の約38.7%を占める米国が、その主な原因です。このトップの座は、この地域の強力なヘルスケアシステム、広範な保険適用、洗練された償還制度によるところが大きいです。さらに、医療費負担適正化法（Affordable Care Act）のような法律の施行によって償還制度が強化され、医療へのアクセス拡大が保証されています。

CAGRが最も高い地域：

予測期間中、アジア太平洋地域が最も高いCAGRを示すと予測されます。医療費の増大、慢性疾患の増加、新興国における保険適用範囲の拡大などが、この急成長を後押しする要因のひとつです。中国やインドのような国では、ヘルスケア・インフラに多額の投資を行っているため、償還サービスに対する需要が増加しています。さらに、この地域の市場は、公的・私的保険制度の拡大やデジタルヘルス技術の採用により拡大しています。

無料のカスタマイズサービス

本レポートをご購読のお客様には、以下の無料カスタマイズオプションのいずれかをご利用いただけます：

• 企業プロファイル
  • 追加市場プレイヤーの包括的プロファイリング（3社まで）
  • 主要企業のSWOT分析（3社まで）
• 地域セグメンテーション
  • 顧客の関心に応じた主要国の市場推計・予測・CAGR（注：フィージビリティチェックによる）
• 競合ベンチマーキング
  • 製品ポートフォリオ、地理的プレゼンス、戦略的提携に基づく主要企業のベンチマーキング

目次

第1章 エグゼクティブサマリー

第2章 序文

• 概要
• ステークホルダー
• 調査範囲
• 調査手法
  • データマイニング
  • データ分析
  • データ検証
  • 調査アプローチ
• 調査資料
  • 1次調査資料
  • 2次調査情報源
  • 前提条件

第3章 市場動向分析

• 促進要因
• 抑制要因
• 機会
• 脅威
• 新興市場
• COVID-19の影響

第4章 ポーターのファイブフォース分析

• 供給企業の交渉力
• 買い手の交渉力
• 代替品の脅威
• 新規参入業者の脅威
• 競争企業間の敵対関係

第5章 世界のヘルスケア償還市場：請求別

• 低賃金
• 全額支払い済み
• 過払い請求
• 拒否された請求

第6章 世界のヘルスケア償還市場：支払者別

• 民間支払者
• 公的支払者

第7章 世界のヘルスケア償還市場：サービスプロバイダー別

• 病院
• 医師の診療所
• 診断検査室
• その他のサービスプロバイダー

第8章 世界のヘルスケア償還市場：地域別

• 北米
  • 米国
  • カナダ
  • メキシコ
• 欧州
  • ドイツ
  • 英国
  • イタリア
  • フランス
  • スペイン
  • その他欧州
• アジア太平洋
  • 日本
  • 中国
  • インド
  • オーストラリア
  • ニュージーランド
  • 韓国
  • その他アジア太平洋地域
• 南米
  • アルゼンチン
  • ブラジル
  • チリ
  • その他南米
• 中東・アフリカ
  • サウジアラビア
  • アラブ首長国連邦
  • カタール
  • 南アフリカ
  • その他中東とアフリカ

第9章 主な発展

• 契約、パートナーシップ、コラボレーション、ジョイントベンチャー
• 買収と合併
• 新製品発売
• 事業拡大
• その他の主要戦略

第10章 企業プロファイリング

• 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
• MetLife, Inc.

List of Tables

• Table 1 Global Healthcare Reimbursement Market Outlook, By Region (2024-2032) ($MN)
• Table 2 Global Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 3 Global Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 4 Global Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 5 Global Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 6 Global Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 7 Global Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 8 Global Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 9 Global Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 10 Global Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 11 Global Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 12 Global Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 13 Global Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 14 Global Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)
• Table 15 North America Healthcare Reimbursement Market Outlook, By Country (2024-2032) ($MN)
• Table 16 North America Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 17 North America Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 18 North America Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 19 North America Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 20 North America Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 21 North America Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 22 North America Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 23 North America Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 24 North America Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 25 North America Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 26 North America Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 27 North America Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 28 North America Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)
• Table 29 Europe Healthcare Reimbursement Market Outlook, By Country (2024-2032) ($MN)
• Table 30 Europe Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 31 Europe Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 32 Europe Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 33 Europe Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 34 Europe Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 35 Europe Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 36 Europe Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 37 Europe Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 38 Europe Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 39 Europe Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 40 Europe Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 41 Europe Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 42 Europe Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)
• Table 43 Asia Pacific Healthcare Reimbursement Market Outlook, By Country (2024-2032) ($MN)
• Table 44 Asia Pacific Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 45 Asia Pacific Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 46 Asia Pacific Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 47 Asia Pacific Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 48 Asia Pacific Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 49 Asia Pacific Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 50 Asia Pacific Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 51 Asia Pacific Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 52 Asia Pacific Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 53 Asia Pacific Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 54 Asia Pacific Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 55 Asia Pacific Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 56 Asia Pacific Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)
• Table 57 South America Healthcare Reimbursement Market Outlook, By Country (2024-2032) ($MN)
• Table 58 South America Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 59 South America Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 60 South America Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 61 South America Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 62 South America Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 63 South America Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 64 South America Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 65 South America Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 66 South America Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 67 South America Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 68 South America Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 69 South America Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 70 South America Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)
• Table 71 Middle East & Africa Healthcare Reimbursement Market Outlook, By Country (2024-2032) ($MN)
• Table 72 Middle East & Africa Healthcare Reimbursement Market Outlook, By Claim (2024-2032) ($MN)
• Table 73 Middle East & Africa Healthcare Reimbursement Market Outlook, By Underpaid (2024-2032) ($MN)
• Table 74 Middle East & Africa Healthcare Reimbursement Market Outlook, By Fully Paid (2024-2032) ($MN)
• Table 75 Middle East & Africa Healthcare Reimbursement Market Outlook, By Overpaid Claims (2024-2032) ($MN)
• Table 76 Middle East & Africa Healthcare Reimbursement Market Outlook, By Denied Claims (2024-2032) ($MN)
• Table 77 Middle East & Africa Healthcare Reimbursement Market Outlook, By Payer (2024-2032) ($MN)
• Table 78 Middle East & Africa Healthcare Reimbursement Market Outlook, By Private Payers (2024-2032) ($MN)
• Table 79 Middle East & Africa Healthcare Reimbursement Market Outlook, By Public Payers (2024-2032) ($MN)
• Table 80 Middle East & Africa Healthcare Reimbursement Market Outlook, By Service Provider (2024-2032) ($MN)
• Table 81 Middle East & Africa Healthcare Reimbursement Market Outlook, By Hospitals (2024-2032) ($MN)
• Table 82 Middle East & Africa Healthcare Reimbursement Market Outlook, By Physician Offices (2024-2032) ($MN)
• Table 83 Middle East & Africa Healthcare Reimbursement Market Outlook, By Diagnostic Laboratories (2024-2032) ($MN)
• Table 84 Middle East & Africa Healthcare Reimbursement Market Outlook, By Other Service Providers (2024-2032) ($MN)

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

Market Dynamics:

Driver:

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.

Restraint:

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.

Opportunity:

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.

Threat:

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.

Covid-19 Impact:

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.

Region with largest share:

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.

Region with highest CAGR:

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.

Key Developments:

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.

Claims Covered:

• Underpaid
• Fully Paid
• Overpaid Claims
• Denied Claims

Payers Covered:

• Private Payers
• Public Payers

Service Providers Covered:

• Hospitals
• Physician Offices
• Diagnostic Laboratories
• Other Service Providers

Regions Covered:

• North America
  • US
  • Canada
  • Mexico
• Europe
  • Germany
  • UK
  • Italy
  • France
  • Spain
  • Rest of Europe
• Asia Pacific
  • Japan
  • China
  • India
  • Australia
  • New Zealand
  • South Korea
  • Rest of Asia Pacific
• South America
  • Argentina
  • Brazil
  • Chile
  • Rest of South America
• Middle East & Africa
  • Saudi Arabia
  • UAE
  • Qatar
  • South Africa
  • Rest of Middle East & Africa

What our report offers:

• Market share assessments for the regional and country-level segments
• Strategic recommendations for the new entrants
• Covers Market data for the years 2024, 2025, 2026, 2028, and 2032
• Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
• Strategic recommendations in key business segments based on the market estimations
• Competitive landscaping mapping the key common trends
• Company profiling with detailed strategies, financials, and recent developments
• Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

• Company Profiling
  • Comprehensive profiling of additional market players (up to 3)
  • SWOT Analysis of key players (up to 3)
• Regional Segmentation
  • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
• Competitive Benchmarking
  • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

• 2.1 Abstract
• 2.2 Stake Holders
• 2.3 Research Scope
• 2.4 Research Methodology
  • 2.4.1 Data Mining
  • 2.4.2 Data Analysis
  • 2.4.3 Data Validation
  • 2.4.4 Research Approach
• 2.5 Research Sources
  • 2.5.1 Primary Research Sources
  • 2.5.2 Secondary Research Sources
  • 2.5.3 Assumptions

3 Market Trend Analysis

• 3.1 Introduction
• 3.2 Drivers
• 3.3 Restraints
• 3.4 Opportunities
• 3.5 Threats
• 3.6 Emerging Markets
• 3.7 Impact of Covid-19

4 Porters Five Force Analysis

• 4.1 Bargaining power of suppliers
• 4.2 Bargaining power of buyers
• 4.3 Threat of substitutes
• 4.4 Threat of new entrants
• 4.5 Competitive rivalry

5 Global Healthcare Reimbursement Market, By Claim

• 5.1 Introduction
• 5.2 Underpaid
• 5.3 Fully Paid
• 5.4 Overpaid Claims
• 5.5 Denied Claims

6 Global Healthcare Reimbursement Market, By Payer

• 6.1 Introduction
• 6.2 Private Payers
• 6.3 Public Payers

7 Global Healthcare Reimbursement Market, By Service Provider

• 7.1 Introduction
• 7.2 Hospitals
• 7.3 Physician Offices
• 7.4 Diagnostic Laboratories
• 7.5 Other Service Providers

8 Global Healthcare Reimbursement Market, By Geography

• 8.1 Introduction
• 8.2 North America
  • 8.2.1 US
  • 8.2.2 Canada
  • 8.2.3 Mexico
• 8.3 Europe
  • 8.3.1 Germany
  • 8.3.2 UK
  • 8.3.3 Italy
  • 8.3.4 France
  • 8.3.5 Spain
  • 8.3.6 Rest of Europe
• 8.4 Asia Pacific
  • 8.4.1 Japan
  • 8.4.2 China
  • 8.4.3 India
  • 8.4.4 Australia
  • 8.4.5 New Zealand
  • 8.4.6 South Korea
  • 8.4.7 Rest of Asia Pacific
• 8.5 South America
  • 8.5.1 Argentina
  • 8.5.2 Brazil
  • 8.5.3 Chile
  • 8.5.4 Rest of South America
• 8.6 Middle East & Africa
  • 8.6.1 Saudi Arabia
  • 8.6.2 UAE
  • 8.6.3 Qatar
  • 8.6.4 South Africa
  • 8.6.5 Rest of Middle East & Africa

9 Key Developments

• 9.1 Agreements, Partnerships, Collaborations and Joint Ventures
• 9.2 Acquisitions & Mergers
• 9.3 New Product Launch
• 9.4 Expansions
• 9.5 Other Key Strategies

10 Company Profiling

• 10.1 Anthem, Inc
• 10.2 Cigna Corporation
• 10.3 Nippon Life Insurance Company Limited
• 10.4 Aetna Inc.
• 10.5 Humana Inc.
• 10.6 CVS Health Corporation
• 10.7 Allianz Care (Allianz Group)
• 10.8 Molina Healthcare, Inc.
• 10.9 Centene Corporation
• 10.10 Agile Health Insurance
• 10.11 WellCare Health Plans, Inc.
• 10.12 UnitedHealth Group Incorporated
• 10.13 Health Care Service Corporation (HCSC)
• 10.14 Aviva plc
• 10.15 MetLife, Inc.