Healthcare Reimbursement Market Size, Share & Trends Analysis Report By Claim (Underpaid, Full Paid), By Payer, By Service Provider (Physician Office, Diagnostic Laboratories), By Region, And Segment Forecasts

Published Date: May - 2025 | Publisher: MIR | No of Pages: 250 | Industry: healthcare | Format: Report available in PDF / Excel Format

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Healthcare Reimbursement Market Trends

The size of the global healthcare reimbursement market was estimated at USD 9,720.5 billion in 2024 and is expected to grow at a CAGR of 5.4% from 2025 to 2035. The market growth of this market is mainly driven by factors like the increasing cost of healthcare services, in-patient procedures, and medical devices. The increasing demand for insurance-based healthcare reimbursement is fueled by the increasing use of technology tools and innovation in designing and developing reimbursement models. Incorporation of patient health information, medical records, and treatment patterns has also driven the growth of this market.

The growth in the incidence of more than one chronic disease, the surge in new cases of trauma injuries and accidents of all types, and the enhanced need for increased healthcare infrastructure and services aided by technology development and improved resources are proving to be important factors driving the healthcare reimbursement market growth. Based on the Centers for Medicare & Medicaid Services' (CMS) Office of the Actuary National Health Expenditure Projections, health care expenditure proportion of GDP in the U.S. will approach one fifth of GDP by 2032.

The high pace of digitalization in the healthcare reimbursement sector, the growing trend of moving away from conventional paper-based processes and documentation to computerized, internet connectivity-based sophisticated systems, and the presence of various software solutions and services for automating various processes in the insurance sector are likely to impact this market throughout the forecast period.

Rising incidence of and growing penetration by cloud technology into various segments of the healthcare insurance and reimbursement market, including monitoring and analysis on real-time and billing and processing of claim application, has been assisting companies to combat issues of revenue leakage as well as administration of processes. Rising digitization of the health sector, innovation through technologies like telehealth, expanding acceptance for virtual care offerings, and distant patient monitoring also are influencing the reimbursement landscape.

Claims and reimbursement regulations, fee-for-service method changes, and adapting compliance strategies to suit regulations in each nation have also impacted the development of this market. As the healthcare service sector accelerates the use of innovation and scientifically sophisticated care options, healthcare service costs rise at a high rate. This calls for efficient healthcare reimbursements for improved patient outcomes.

Health insurance and reimbursement benefits offered by private organizations to their workers, government healthcare benefit programs, and greater focus on value-based healthcare delivery are anticipated to significantly impact the healthcare reimbursement market over the forecast period.

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  • Competitive benchmarking
  • Historical data & forecasts
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Market Concentration & Characteristics

The stage of market growth is high, and growth is gaining momentum. The market for healthcare reimbursement is marked by a high level of innovation. Some of the most important trends in innovation are automation of administrative processes, increasing efficiency and reducing errors; digitalization by Electronic Health Records (EHRs) and patient portals, enhancing accuracy and patient satisfaction; value-based care models that support improved health outcomes; and AI uses for claims processing and fraud detection, eventually leading to a more efficient, transparent, and patient-focused system.

The market is also marked by moderate mergers and acquisitions to support consolidation trends toward end-to-end revenue cycle management (RCM) solutions, technological innovation in the form of AI and data analytics, and private equity investment in high-growth firms. The transformation to value-based care and the outsourcing of RCM services are also fueling this consolidation as providers look for greater efficiency and compliance with regulatory changes. For example, Blue Cross and Blue Shield of Texas bought Cigna Healthcare's Medicare Advantage and associated businesses in March 2025 in a bid to consolidate services without compromising member benefits and by sharing regular operating developments.

Healthcare reimbursement regulatory environment consists of stringent data privacy acts like HIPAA and GDPR, for which compliance is needed while dealing with sensitive information. Proper medical coding according to standards like ICD-10 and HCPCS is a must, while regulations are implemented to avoid fraud. Reimbursement schemes are moving towards value-based care (VBC), impacting payer policies and creating demand for cost-efficient, technologically connected solutions.

Other reimbursement models like value-based care and direct patient payments are moderate substitution threats. Even though the conventional insurance is still in the lead, gradual uptake of new models due to regulatory complexity and resistance from providers keeps conventional reimbursement models in the game in the healthcare industry.

Healthcare systems, including clinics and hospitals, use reimbursement solutions for revenue cycle management, whereas payers like insurance firms process claims and manage compliance. In addition, patients interact through portals for billing transparency. Outsourcing of RCM activities is increasingly focusing end-user dependence on specialty RCM firms.

Claim Insights

The underpaid segment was the market leader with a revenue share of 81.2% in 2024. Underpaid claims frequently occur due to billing and filing mistakes, contract differences, insurance processing or calculation mistakes, and so on. Patients who do not provide the required documents and valid evidence about healthcare services utilized under contracts are underpaid in reimbursements. This has caused severe conflicts in the healthcare sector. Consequently, out-of-pocket (OOP) healthcare spending in the United States has risen considerably over the past decades. On average, payments for inpatient and outpatient behavioral health care were 34% & 43%, respectively, below cost across all payers, as reported by the American Health Association.

The paid segment full is anticipated to witness high CAGR throughout the forecast period, due to rising adoption of digitization and cloud technology, which results in lower errors, the availability of efficient claim management systems, and the proactive nature of insurance companies to offer supportive policy frameworks. Government backing, stringent regulations, and framework reforms according to digital claims are anticipated to support this growth throughout the forecast period.

Payer Insights

The public payers held the greatest share in the worldwide market of healthcare reimbursements during 2024. This is due to deeply entrenched trust over full payment by public payers in several nations, particularly in countries of mid or low income levels, history of full payment, the government's entry into several public insurance businesses and others. Modifications of newly crafted policies and bills to secure increasing full payments by insurers also determine the expansion of this market. For example, the Affordable Care Act allowed U.S. states to extend the coverage of Medicaid, to adults with incomes up to 138 % of the established poverty levels.

The private payers segment is anticipated to witness the highest CAGR of 6.6% over the forecast period. Successful engagement tactics of private companies, improved portfolios providing a variety of options in insurance, and the availability of experienced professionals employed in the sector are impacting this segment. Increased competition in the private insurance sector and technological advancements implemented by several companies for full coverage and speedy settlement of claims through digital platforms are likely to drive the growth of this segment in the forecast period.

Service Provider Insights

The physician office segment accounted for the highest revenue share of 47.4% in 2024. This is because of higher hospital admissions due to the rising incidence of chronic diseases, better hospital infrastructures in various countries with developing economies, an increasing number of specialty hospitals, and so on. Hospital costs with sophisticated healthcare technologies, including emergency care services, inpatient care, specialized surgeries, and others, require reimbursements.

The physician office market will be anticipated to experience the highest CAGR during the period from 2025 to 2030. This market is majorly driven by a trend toward outpatient treatment and ambulatory services and increased trends toward hospital admissions avoidance as long as possible. The greater expenses of in-patient procedures and specialty hospital admission motivate patients and individuals to opt for healthcare services from physician's offices. Moreover, the presence of value-based care methods and personalized services is also drawing a lot of patients towards this segment. The presence of cost-effective diagnostic technologies and the trend of early diagnosis and treatments are anticipated to build a surging demand for this market in the coming years.

Regional Insights

Market Analysis

North America dominated the global market of healthcare reimbursement and accounted for a revenue share of 45.7% in 2024. The region’s positive regulatory scenario regarding reimbursements and healthcare insurance primarily drives this market. The presence of multiple public payers also influences its growth. In addition, government support and encouragement for ensuring a rise in healthcare-insured individuals contribute to the development.

U.S. Healthcare Reimbursement Market Trends

The U.S. healthcare reimbursement market dominated the regional industry in 2024. This is attributed to multiple factors, such as rising healthcare costs, the high prevalence of chronic diseases such as cancer and cardiovascular diseases, and the increase in technological innovations adopted by the key companies in the market. According to the National Cancer Institute at the National Institutes of Health, 2,001,140 new cancer cases in the U.S. were estimated to be diagnosed in 2023.

Europe Healthcare Reimbursement Market Trends

Europe was identified as a lucrative region in 2024. This market is mainly influenced by factors such as the large geriatric population, rising prevalence of chronic diseases such as diabetes and respiratory diseases, effective penetration of public healthcare assistance and funding, and more.

Healthcare reimbursement market in Germany held a significant revenue share in 2024. The country's robust healthcare system, regulations such as mandating health insurance for all residents, and rising healthcare innovations are expected to assist the growth of this market in the approaching years.

Latin America Healthcare Reimbursement Market Trends

Latin America healthcare reimbursement market is expected to experience the fastest CAGR of 19.7% over the forecast period. This is attributed to the rise in healthcare expenditures and increased costs associated with healthcare services, advancements and adoption of technologies such as Health Technology Assessment (HTA), and growing focus on ensuring enhanced availability of healthcare insurance by public and private sector companies in the region.

Key Healthcare Reimbursement Company Insights

Some of the key companies in the healthcare reimbursement market include United HealthCare Services, Inc., Allianz Care, CVS Health, Reliance Nippon Life Insurance Company Limited, and others. To address the growing competition, major companies in the market are adopting strategies such as streamlining reimbursement processes through technology adoption, increasing focus on collaborations with hospitals and organizations, and more.

  • CVS Health, one of the prominent healthcare services organizations, provides multiple offerings, including commercial health coverage, condition management, health and wellness products, mental health services, and others. It also offers prescription drug coverage and pharmacy services.

  • United HealthCare Services, Inc., a major health insurance and services organization in the U.S., offers a range of services, including Medicare, individual & family plans for short terms, self-employed plans, student plans, all supplement plans, dental plans, vision plans, and others.

Key Healthcare Reimbursement Companies

The following are the leading companies in the healthcare reimbursement market. These companies collectively hold the largest market share and dictate industry trends.

Recent Developments

  • In March 2025, Cigna Healthcare’s Global Health Benefits announced a new solution supported by Carrot Fertility. This initiative intended to introduce a comprehensive program supporting fertility, family-building, and hormonal health for globally mobile customers and their partners.

  • In November 2024, KindlyMD partnered with UnitedHealth care Insurance, the largest health insurer in the U.S., to expand the former’s coverage and access to Utah-based hospitals, enhancing patient service.

  • In September 2024, Cigna Healthcare introduced E-Treatment option through MDLIVE (Evernorth). This has made MDLIVE virtual care available for individuals who have Cigna Healthcare insurance derived from the Affordable Care Act.

Healthcare Reimbursement Market Report Scope

Report Attribute

Details

Market size value in 2025

USD 10,238.7 billion

Revenue forecast in 2030

USD 13,315.0 billion

Growth rate

CAGR of 5.4% from 2025 to 2035

Base year for estimation

2024

Historical data

2018 - 2023

Forecast period

2025 - 2035

Quantitative units

Revenue in USD billion and CAGR from 2025 to 2035

Report coverage

Revenue forecast, company ranking, competitive landscape, growth factors, trends

Segments covered

Claim, payer, service provider, region

Regional scope

North America; Europe; Asia Pacific; Latin America; Middle East & Africa

Country scope

U.S., Canada, Mexico, UK, Germany, France, Italy, Spain, Denmark, Sweden, Norway, China, Japan, India, Australia, South Korea, Thailand, Brazil, Argentina, South Africa, Saudi Arabia, UAE, Kuwait

Key companies profiled

United HealthCare Services, Inc.; Allianz Care; CVS Health; Reliance Nippon Life Insurance Company Limited; Cigna Healthcare; Aviva; BNPP Paribas Cardif; Wellcare Health Plans, Inc.; Agile Health; Violet Cross Blue Cover Association

Customization scope

Free report customization (equivalent up to 8 analysts working days) with purchase. Addition or alteration to country, regional & segment scope.

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Avail customized purchase options to meet your exact research needs. Explore purchase options

Global Healthcare Reimbursement Market Report Segmentation

Claim Outlook (Revenue, USD Billion, 2018 - 2030)

    • Underpaid

    • Full Paid

  • Payer Outlook (Revenue, USD Billion, 2018 - 2035)

    • Private Payers

    • Public Payers

  • Service Provider Outlook (Revenue, USD Billion, 2018 - 2035)

    • Hospitals

    • Physician Office

    • Diagnostic Laboratories

    • Other Service Providers

  • Regional Outlook (Revenue, USD Billion, 2018 - 2035)

    • North America

      • U.S.

      • Canada

      • Mexico

    • Europe

      • UK

      • Germany

      • France

      • Italy

      • Spain

      • Denmark

      • Sweden

      • Norway

    • Asia Pacific

      • Japan

      • China

      • India

      • Australia

      • South Korea

      • Thailand

    • Latin America

      • Brazil

      • Argentina

    • Middle East & Africa

      • South Africa

      • Saudi Arabia

      • UAE

      • Kuwait

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