The global healthcare payer services market size was estimated at US$ 45 billion in 2022 and is expected to reach over US$ 91.46 billion by 2032, expanding growth at a CAGR of 7.40% from 2023 to 2032.
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The U.S. healthcare payer services market size was estimated at US$ 8.37 billion in 2023 and is expected to reach over US$ 17.01 billion by 2032, expanding growth at a CAGR of 7.40% from 2023 to 2032.
Based on the region, the North America segment dominated the global healthcare payer services market in 2022, in terms of revenue and is estimated to sustain its dominance during the forecast period. The U.S. accounted major market share in the North America region. This is due to a number of variables, including rising healthcare insurance membership and the presence of a favorable reimbursement regulatory frameworks.
On the other hand, the Asia-Pacific is estimated to be the most opportunistic segment during the forecast period. India is one of the leading countries in the global knowledge process outsourcing services sector. Furthermore, China and Japan are significantly contributing to the global healthcare payer services market.
Healthcare payer services are services that healthcare insurance payers and providers contract out. Various outsourcing solutions are being used by healthcare insurance providers and payers to improve their business processes and give better service to their consumers. Outsourcing has emerged as a viable business strategy for reducing administrative, logistics, procurement, and other responsibilities while developing cost-effective business processes.
The healthcare payer services market is likely to be driven by rising insurance enrollments, an increase in healthcare fraud, and an increased usage of analytics in healthcare during the projected period. Some reasons, such as the increasing use of digital technologies in payer operations, increased consumer demand, and a rise in mergers and acquisitions, are expected to enhance the industry in the next years.
Furthermore, one of the key drivers projected to fuel the healthcare payer services market expansion over the forecast period is the increased engagement of a broader population, beyond front and back-end office operations, to drive the effectiveness and efficiency across corporate processes.
The growing demand for healthcare payer services can be linked to the growing requirement to run business processes more cost-effectively through the use of engagement and contract models. In addition, healthcare payer services improve patient care by streamlining the process and improving customer communication. The healthcare payer services are also useful in billing and account administration, analytics and fraud management, and human resource services and claims management.
Due to the growing number of healthcare payer service providers and the increasing demand to decrease costs, the healthcare payer services market is predicted to increase during the forecast period. When compared to in-house payer services, outsourcing healthcare payer services is less expensive. The number of clients is expanding, due to increasing technical advancements and increased acceptance of analytics in healthcare, as well as an increasing number of people opting for healthcare insurance. All these factors are likely to drive the growth of the healthcare payer services market during the forecast period.
However, issues such as the rising frequency of cyber theft that is the loss of personal data, and the hidden costs associated with outsourcing are projected to stifle the healthcare payer services market’s growth during the forecast period.
On the other hand, the developed information technology (IT) and healthcare infrastructure, as well as an expanding number of healthcare payer services providers, are likely to boost the healthcare payer services market’s expansion.
| Report Highlights | Details |
| Market Size | US$ 91.46 billion by 2032 |
| Growth Rate | CAGR of 7.40% from 2022 to 2032 |
| Largest Market | North America |
| Fastest Growing Market | Asia Pacific |
| Base Year | 2022 |
| Forecast Period | 2023 to 2032 |
| Segments Covered | Service, Application, End User, Region |
| Comapnies Mentioned | Hinduja Global Solutions Ltd., Cognizant Technology Solutions, Hexaware Technologies Ltd., HCL Technologies Ltd., Teleperformance Group, Sutherland Global Services, Concentrix Corporation, Wipro Ltd., Accenture Plc., FirstSource Solutions Ltd. |
Based on the service, the business process outsourcing services dominates the healthcare payer services market during the forecast period. The healthcare payer business process outsourcing (BPO) sector is expected to develop due to rising healthcare costs and a growing focus on reducing total administrative costs of member services and claim management services.
On the other hand, the knowledge process outsourcing services is expected to grow at rapid pace during the forecast period. This is attributed to the increased need for highly qualified workers, as well as the cost savings associated with outsourcing high-end procedures to emerging countries.
Based on the application, the analytics and fraud management services dominate the healthcare payer services market during the forecast period. The knowledge process outsourcing services cover a variety of important operations, including fraud monitoring analytics and risk management analytics data analysis.
On the other hand, the claims management services is expected to grow at rapid pace during the forecast period. One of the primary factors likely to fuel the healthcare payer services market is the increased demand for predictive modeling and claim analytics. This is driving the growth of the segment.
Based on the end user, the private dominates the healthcare payer services market during the forecast period. Due to increased private investment in the healthcare payer vertical and growing government assistance to stimulate private investment in the healthcare industry, private payers accounted for largest market share.
On the other hand, the public is expected to grow at rapid pace during the forecast period. The growing healthcare expenditure, constantly falling out-of-pocket expenditure, and the expanding presence of global health insurance are some of the critical aspects projected to positively strengthen the growth of the segment.
Key Companies & Market Share Insights
The major market players are primarily focused on mergers and acquisitions in order to broaden their skills, diversify their company portfolios, and improve healthcare delivery outcomes. Furthermore, these mergers are projected to facilitate population health management by providing incentives that help to improve efficiency while moving toward a quality-driven system. In 2015, Aetna Inc. purchased Humana in order to move toward patient-centered, value-based healthcare.
Segments Covered in the Report
By Service
By Application
By End User
By Geography
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