Healthcare Payer Solution Market Size, Share & Trends Analysis Report By Service (Business Process Outsourcing Services, Information Technology Outsourcing Services, Knowledge Process Outsourcing Services), By Application (Pharmacy Audit & Analysis Systems, Claims Management Services, Fraud Management Services, Computer-assisted Coding (CAC) Systems, Member Eligibility Management Services, Provider Network Management Services, Payment Management Services, Customer Relationship Management Services, Medical Document Management Services, General Ledger & Payroll Management), By End-User (Private Provider, Public Provider) and By Region(North America, Europe, APAC, Middle East and Africa, LATAM) Forecasts, 2023-2031

Market Overview

The global healthcare payer solution market size was valued at USD 25378 million in 2022. It is projected to reach USD 63562 million by 2031, growing at a CAGR of 10.74% during the forecast period (2023–2031).

The healthcare payer solution could be characterized as the services offered by healthcare IT businesses to payers, such as private and public insurers and insurance companies, to assist in streamlining business processes and lowering operational costs. The market dynamics and trends for the global market for healthcare payer solutions are provided in the report. It also includes estimates and forecasts for the market. Healthcare insurance payers and providers use a variety of outsourcing solutions to streamline their operations and provide better customer service. Reduced administrative, logistical, procurement and other responsibilities can be achieved while developing cost-effective business processes thanks to outsourcing, which has emerged as a viable business strategy.

Market Dynamics

What are the Primary Factors driving the Market for Healthcare Payer Solutions?

Increase in Health Insurance Enrolment

Health insurance is required for all public and private employees in developed nations and the majority of developing nations. It is explained by the fact that employees' families, both in the public and private sectors, are covered by health insurance. Health insurance costs are automatically subtracted from an employee's monthly salary. A rise in the number of working professionals globally is also anticipated, thanks to health insurance requirements. As a result, the increase in people signing up for health insurance significantly aids in expanding the global market.

Implementation of Various Healthcare Reforms

Globally, there has been a significant increase in the adoption of healthcare IT solutions. Government organizations worldwide have passed several regulations and created healthcare reforms to encourage the use of healthcare IT solutions in different healthcare settings. Healthcare payers, for instance, are required by U.S. federal mandates to develop strategic plans to cut down on inefficient administrative resources, avoid revenue loss, and maintain fair premiums. According to the Medical Loss Ratio (MLR) requirements of the Patient Protection and Affordable Care Act (ACA), health insurers must devote at least 80% of their premium revenue to settling claims and improving quality, with the remaining 20% allowed to go toward administrative costs, marketing, and profit.

What are the Main Factors that will slow down the Market for Healthcare Payer Solutions?

Increased Instances of Data Breaches and Confidentiality Losses

The internet and cloud services are heavily used in healthcare payer services and solutions. A sizable amount of private patient information is kept in the cloud. Securing patient data is a significant challenge for healthcare organizations due to the rise in cyberattacks globally. Germany and the United Kingdom follow the United States and China in terms of the number of cybercrime attacks. The most significant sources of malicious traffic, such as connected medical endpoints, personal health data exposed to the internet, security systems, and edge devices, are related to non-traditional endpoints, which are the focus of most security threats. Therefore, it is anticipated that the rise in data breaches will impede the market's expansion for healthcare payer solutions.

What are the Future Opportunities for Healthcare Payer Solutions?

High Growth Potential in Emerging Economies

Healthcare payer technology solutions can grow their businesses at a profit in developing nations. The healthcare sector's ongoing improvement drives market expansion in developing nations like India and China. The government's initiatives to cut back on wasteful healthcare spending have also significantly boosted emerging markets. Additionally, a surge in the uptake of healthcare IT solutions in emerging economies is anticipated to support market expansion. A large population base still uninsured makes developing nations in the Asia-Pacific and LAMEA region have high growth potential. Therefore, the abovementioned factors will likely present lucrative opportunities for market expansion in developing countries.

Regional Analysis

The global healthcare payer solution market is bifurcated into four regions, namely North America, Europe, Asia-Pacific, and LAMEA.

North America Dominates the Global Market

North America is the most significant shareholder in the global healthcare payer solution market. It is attributed to several factors, including an increase in government focus on containing high healthcare costs, which will maximize profit margins and reduce operational costs of providing healthcare. The US, Canada, and Mexico all research the North American health insurance market. Due to its affordable healthcare and favorable health insurance environment, the U.S. contributed the largest market share in the region. Additionally, the increase in insurance enrollments, U.S. federal healthcare mandates, healthcare scams, and a shortage of skilled workers domestically all contribute to the market's expansion.

Europe is expected to grow during the forecast period. Germany, France, the United Kingdom, Spain, Italy, and the rest of Europe are among the major European nations taken into account in the report. It is explained by the requirement for health insurance for everyone who lives and works in the European Union. In the governments of European nations like the UK, Germany, and France, health insurance is required. Additionally, a sizable increase in spending by the European Union to encourage the adoption of healthcare IT among EU countries has been observed, which is anticipated to present lucrative opportunities for market expansion.

Japan, China, India, and the rest of Asia-Pacific are the nations that have been examined. Due to rising healthcare costs and the abundance of better healthcare services, this region presents lucrative opportunities for the healthcare payer solution market. It is predicted to grow at the fastest rate during the forecast period. Additionally, essential players like Hinduja Global Solutions Limited and HCL Technologies Limited significantly aid in expanding the healthcare payer solution market.

LAMEA is an emerging market because it is expected that healthcare spending will increase over the forecast period, offering market participants lucrative growth opportunities. The market for healthcare payer solutions is expanding due to rising daily medical costs in most Latin American nations and laws requiring employers to offer health insurance to their employees. Additionally, a rise in the population's disposable income fuels the expansion of the private health insurance sector, which is anticipated to spur the market for healthcare payer solutions.

Segmental Analysis

The global healthcare payer solution market is segmented by service, application, and end-user.

Based on service, the global healthcare payer solution market is bifurcated into business process outsourcing services, information technology outsourcing services, and knowledge process outsourcing services.

The business process outsourcing services segment is the highest contributor to the market. Healthcare business process outsourcing (BPO) is where a healthcare provider outsources its non-core functions to a third party. The healthcare BPO industry offers various services, including data entry and medical claims processing. Assist the payers; the BPO industry uses various IT tools, such as analytics, automation, and artificial intelligence. BPO on the cloud has completely changed how businesses outsource work. Various BPO service providers are increasing their cloud computing investments to broaden their portfolios.

Based on application, the global healthcare payer solution market is bifurcated into pharmacy audit & analysis systems, claims management services, fraud management services, computer-assisted coding systems, member eligibility management services, provider network management services, payment management services, customer relationship management services, medical document management services, and general ledger & payroll management.

The claims management services segment is the highest contributor to the market. Solutions for claims management deal with all phases of the processing, filing, and billing medical claims. Claim management systems are created for fast and accurate claims processing because maintaining patient records manually and communicating with healthcare insurance providers takes time. Claims management services also identify and stop excessive, double, and fraudulent payments.

Based on end-user, the global healthcare payer solution market is bifurcated into private providers and public providers.

The public provider segment is the highest contributor to the market. Public provider insurance is health insurance offered by federal, state, or local governments. This insurance offers a more cost-effective alternative for those without health insurance who cannot afford the high premiums charged by private health insurance companies. Public health insurance is advantageous for those with low and middle incomes because there are no co-pays or deductibles. However, the burden of healthcare costs has increased due to wasteful spending. Additionally, a growing number of public health payers are choosing healthcare payer solutions, which is anticipated to present opportunities for market expansion.

Recent Developments

• November 2022- Wipro will provide support for AWS's new Cybersecurity Data Lake Service.
• December 2022- Accenture completes the acquisition of the personnel and business resources of ARZ.