의료비 환급 시장 : 청구별, 지불자별, 서비스 제공업체별, 지역별 세계 분석 및 예측(-2032년)

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.