Healthcare reimbursement is the payment that hospitals, diagnostic facilities, doctors, or other health care providers receive for providing medical service to people.
Healthcare reimbursement is the payment that hospitals, diagnostic facilities, doctors, or other health care providers receive for providing medical service to people. Often, government payer or health insurer covers a person’s health care expenses partially or fully. Depending on the health insurance plan opted for, the person can claim the reimbursement money from the health insurance provider.
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Typically, the payment is made after receiving medical service, which is why it is called reimbursement. Advancement in the technology of electronic medical record (EMR) for monitoring patient responsiveness, provider practice, and functioning of health care organizations have the potential to not only strengthen the efficiency and accuracy of reimbursement mechanisms but also to refine the quality of medical care.
According to Medicare, in 2017, it’s benefit payments equaled to US$ 702 Bn, which was an increase from US$ 425 Bn in 2007. Medicare’s per capita expenditure is anticipated to increase at an average annual rate of 4.6 percent during the next 10 years, due to increase in use of services and intensity of care, growing Medicare enrollment, and rising health care prices.
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According to the 2017 Employer Health Benefits Survey released by Kaiser Family Foundation, employer-sponsored health plans are now incorporating reimbursement arrangement, and the trend is on the rise.
Growing patient population, rising prevalence of chronic diseases, initiatives taken by public and private entities, increasing cost of health care which encourages stakeholder’s interest in reimbursement, and rising awareness among people regarding health insurance policies are driving the global healthcare reimbursement market. However, deteriorated quality of care available for patients in need of high-cost treatments and administrative burden often faced by clinicians are likely to hinder the growth of the market during the forecast period.
In terms of claim, the global healthcare reimbursement market can be divided into fully paid and underpaid. The underpaid segment is anticipated to hold the leading share of the global healthcare reimbursement market due to unnecessary utilization of health care services, resulting in underpaid settlements and rise in the number of false claims. Based on payer, the healthcare reimbursement market can be segmented into private payers and public payers. The private payers segment is expected to dominate the global market due to the presence of large number of private players in the market.
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In terms of provider, the healthcare reimbursement market can be classified into physician offices, hospitals, diagnostic laboratories, and others. Hospitals are projected to be the leading segment in the healthcare reimbursement market due to increasing number of surgeries performed in hospital settings and growing geriatric population utilizing the services of hospitals across the world.
Based on geography, the global healthcare reimbursement market can be segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America is anticipated to dominate the global healthcare reimbursement market due to presence of large number of insurance payers, strong reimbursement framework, and prevalence of the Affordable Care Act in the U.S. which makes its mandatory for people to have health insurance coverage. The healthcare reimbursement market in Asia Pacific is expected to register significant CAGR during the forecast period owing to rise in prevalence of chronic diseases, growing geriatric population, and supporting initiatives taken by the government in the health care sector in the region.
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Key players operating in the global healthcare reimbursement market include UnitedHealth Group, CVS Health, Aetna Inc., Aviva Life Insurance Company India Ltd., Allianz, Reliance Nippon Life Insurance Company Limited, BNP Paribas, WellCare Health Plans, Inc., AgileHealthInsurance, and Blue Cross Blue Shield Association.
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