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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. 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. 

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. 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. 

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.

This study by TMR is all-encompassing framework of the dynamics of the market. It mainly comprises critical assessment of consumers' or customers' journeys, current and emerging avenues, and strategic framework to enable CXOs take effective decisions.

Our key underpinning is the 4-Quadrant Framework EIRS that offers detailed visualization of four elements:

  • Customer Experience Maps
  • Insights and Tools based on data-driven research
  • Actionable Results to meet all the business priorities
  • Strategic Frameworks to boost the growth journey

The study strives to evaluate the current and future growth prospects, untapped avenues, factors shaping their revenue potential, and demand and consumption patterns in the global market by breaking it into region-wise assessment.

The following regional segments are covered comprehensively:

  • North America
  • Asia Pacific
  • Europe
  • Latin America
  • The Middle East and Africa

The EIRS quadrant framework in the report sums up our wide spectrum of data-driven research and advisory for CXOs to help them make better decisions for their businesses and stay as leaders.

Below is a snapshot of these quadrants.

1. Customer Experience Map

The study offers an in-depth assessment of various customers’ journeys pertinent to the market and its segments. It offers various customer impressions about the products and service use. The analysis takes a closer look at their pain points and fears across various customer touchpoints. The consultation and business intelligence solutions will help interested stakeholders, including CXOs, define customer experience maps tailored to their needs. This will help them aim at boosting customer engagement with their brands.

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3. Actionable Results

The findings presented in this study by TMR are an indispensable guide for meeting all business priorities, including mission-critical ones. The results when implemented have shown tangible benefits to business stakeholders and industry entities to boost their performance. The results are tailored to fit the individual strategic framework. The study also illustrates some of the recent case studies on solving various problems by companies they faced in their consolidation journey.

4. Strategic Frameworks

The study equips businesses and anyone interested in the market to frame broad strategic frameworks. This has become more important than ever, given the current uncertainty due to COVID-19. The study deliberates on consultations to overcome various such past disruptions and foresees new ones to boost the preparedness. The frameworks help businesses plan their strategic alignments for recovery from such disruptive trends. Further, analysts at TMR helps you break down the complex scenario and bring resiliency in uncertain times.

The report sheds light on various aspects and answers pertinent questions on the market. Some of the important ones are:

1. What can be the best investment choices for venturing into new product and service lines?

2. What value propositions should businesses aim at while making new research and development funding?

3. Which regulations will be most helpful for stakeholders to boost their supply chain network?

4. Which regions might see the demand maturing in certain segments in near future?

5. What are the some of the best cost optimization strategies with vendors that some well-entrenched players have gained success with?

6. Which are the key perspectives that the C-suite are leveraging to move businesses to new growth trajectory?

7. Which government regulations might challenge the status of key regional markets?

8. How will the emerging political and economic scenario affect opportunities in key growth areas?

9. What are some of the value-grab opportunities in various segments?

10. What will be the barrier to entry for new players in the market?

With a robust experience in creating exceptional market reports, Transparency Market Research has emerged as one of the trusted market research companies among a large number of stakeholders and CXOs. Every report at Transparency Market Research goes through rigorous research activity in every aspect. The researchers at TMR keep a close watch on the market and extract beneficial growth-boosting points. These points help the stakeholders to strategize their business plans accordingly.

TMR researchers conduct exhaustive qualitative and quantitative research. This research involves taking inputs from the experts in the market, focused attention on recent developments, and others. This method of research makes TMR stand out from other market research firms.

Here's how Transparency Market Research helps the stakeholders and CXOs through the reports:

Inculcation and Evaluation of Strategic Collaborations: The TMR researchers analyze recent strategic activities like mergers, acquisitions, partnerships, collaborations, and joint ventures. All the information is compiled and included in the report.

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Note: Although care has been taken to maintain the highest levels of accuracy in TMR’s reports, recent market/vendor-specific changes may take time to reflect in the analysis.

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Health Care Reimbursement Market

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