Canada Healthcare Claims Management Market Report 2022 to 2030

Canada Healthcare Claims Management Market Analysis

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Canada's healthcare claims management market is likely to grow at a CAGR of 23.4% from a market size of $2.13 Bn in 2022 to $11.48 Bn in 2030. The rise in research and development expenditure in healthcare along with the new technological advancements and the increasing trend of automation in healthcare acts as a growth factor for the market. This report is segmented by component, type, delivery mode, and by end user. Some key players in this market include Accenture, Allscripts, Cerner, AthenaHealth, McKesson, IBM Corporation, and others.

ID: IN10CAHS006 CATEGORY: Healthcare Services GEOGRAPHY: Canada AUTHOR: Dhruv Joshi

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Canada Healthcare Claims Management Market executive summary

The Canada Healthcare Claims Management market size is at around $2.13 Bn in 2022 and is projected to reach $11.48 Bn in 2030, exhibiting a CAGR of 23.4% during the forecast period 2022-2030. Canada is one of the biggest nations in the world and the biggest in the western hemisphere. It has a robust free-market economy with a wide range of businesses, from small owner-managed businesses to large international organizations. Canada's hybrid public-private healthcare system is made up of the public sector, which finances healthcare services, and the private sector, which offers these services. There isn't a standardized national procurement model at the moment. Each province has its own set of laws, and the ones that apply to certain areas or service providers may differ greatly. Healthcare procurement reforms, including centralized methods, are being implemented or examined by provincial government agencies. Healthcare spending in Canada was approximately 10.84% in 2019, and out-of-pocket expenses as a share of current healthcare spending were approximately 14.91%.

In response to mounting financial demands, governments are redesigning conventional service delivery models to maximize value across health systems. Health claims administration is undergoing a significant shift across Canada as a result of changing governmental laws, increasing administration complexity, and the rising need for supporting technologies. Public sector health claims administration systems are undergoing or about to go through significant change across Canada. The medical, pharmaceuticals, and workers' compensation board claims administration systems currently in operation do not satisfy present and future government demands. Payments to physicians in Canada nearly doubled between 1999 and 2010, but only a smaller amount was connected to fee-for-service payments. This indicates a change in physician payment schemes and reveals a chance to overhaul the entire health claims processing system.

canada healthcare claims management market analysis

Market Dynamics

Market Growth Drivers

After the COVID-19 pandemic's climax in March 2020, when medical offices were compelled to increase billing and payment owing to new pandemic realities, the market for healthcare claims management has benefited. The procedure was made possible despite the lack of staff by the use of healthcare IT technologies such as medical billing software, practice management software, and electronic health records (EHR)/electronic medical records (EMR). This attracted the attention of customers and rivals, which contributed to the continued use, emphasis on improvement, and dependence on such minor human involvement software throughout time.

Despite the market's anticipated expansion, worries regarding data privacy are becoming more widespread. As technology develops, it is becoming more common to handle, store, and retrieve such claims data using contemporary technologies like the cloud, mobile, and next-generation databases. Because of a combination of these concerns, the healthcare industry as a whole continues to worry about healthcare data security. To guarantee that patients have the data privacy they need and deserve, laws and regulations governing healthcare data are continually developing. These are some of the elements that help the market expand.

Market Restraints

Understanding the doctor's total remuneration is challenging since data must be gathered from numerous sources. Linkages to health outcomes and individual health measurements are challenging due to a lack of integration and technological skills, and it is unclear which model components have an impact on health outcomes. Also, how some transitioning from FFS (Fee-For-Service) compensation schemes necessitates costly and time-consuming workarounds, such as shadow billing hampers the market growth.

Competitive Landscape

Key Players

Allscripts Healthcare
Accenture
Cerner Corporation
Optum Health
AthenaHealth
McKesson Corporation
IBM Corporation

Healthcare Policies and Regulatory Landscape

Ontario healthcare facilities (including their associated healthcare providers) have used the Health Claims for Auto Insurance (HCAI) system to submit Ontario Claims Forms (OCFs) to Ontario-licensed auto insurers. In order to gather information on Ontario auto insurance health claims for statistical purposes, the Insurance Bureau of Canada (IBC) has agreements with the Financial Services Regulatory Authority of Ontario (FSRA) and, later, with Health Claims for Auto Insurance Processing (HCAIP), which runs the HCAI system.

The organization in charge of regulating the life and health insurance market in Ontario, including accident and illness insurance, is the Financial Services Regulatory Authority of Ontario (FSRA). The FSRA's job is to make that agents and organizations who sell life and health insurance follow all applicable laws in Ontario, especially those pertaining to licencing requirements.

1. Executive Summary
1.1 Service Overview
1.2 Global Scenario
1.3 Country Overview
1.4 Healthcare Scenario in Country
1.5 Healthcare Services Market in Country
1.6 Recent Developments in the Country

2. Market Size and Forecasting
2.1 Market Size (With Excel and Methodology)
2.2 Market Segmentation (Check all Segments in Segmentation Section)

3. Market Dynamics
3.1 Market Drivers
3.2 Market Restraints

4. Competitive Landscape
4.1 Major Market Share

4.2 Key Company Profile (Check all Companies in the Summary Section)

4.2.1 Company
4.2.1.1 Overview
4.2.1.2 Product Applications and Services
4.2.1.3 Recent Developments
4.2.1.4 Partnerships Ecosystem
4.2.1.5 Financials (Based on Availability)

5. Reimbursement Scenario
5.1 Reimbursement Regulation
5.2 Reimbursement Process for Services
5.3 Reimbursement Process for Treatment

6. Methodology and Scope

Healthcare Claims Management Market Segmentation

By Component (Revenue, USD Billion):

Further breakdown of the software and services segment of the healthcare claims management market

Software
Services

By Type (Revenue, USD Billion):

Although they have nothing to do with it, skills unrelated to patient care are equally crucial for any healthcare organization that wants to stay in business. Among these are managing intricate insurance regulations, comprehending best practices for data collection, and analyzing data to identify areas for development. For the above reasons, providers are constantly looking for methods to improve claim administration and medical billing systems. Setting up an integrated billing and claims processing system is one approach to accomplish this, which has a number of benefits.

Integrated Solutions
Standalone Solutions

By Delivery Mode (Revenue, USD Billion):

On-Premise
Cloud-Based

By End User (Revenue, USD Billion):

Healthcare Payers
Healthcare Providers
Other End Users

Healthcare payers in this market are anticipated to rise quickly over the course of the projection period because of the installation of strict regulatory requirements, a lack of experienced personnel internally for claims processing, rising healthcare expenditures, and fraud associated with those charges. Payers have also assisted healthcare providers by creating a web-based and cloud-based interface that helps them manage medical billing and associated claims and offers accurate and timely information about the epidemic.

Methodology for Database Creation

Our database offers a comprehensive list of healthcare centers, meticulously curated to provide detailed information on a wide range of specialties and services. It includes top-tier hospitals, clinics, and diagnostic facilities across 30 countries and 24 specialties, ensuring users can find the healthcare services they need.

Additionally, we provide a comprehensive list of Key Opinion Leaders (KOLs) based on your requirements. Our curated list captures various crucial aspects of the KOLs, offering more than just general information. Whether you're looking to boost brand awareness, drive engagement, or launch a new product, our extensive list of KOLs ensures you have the right experts by your side. Covering 30 countries and 36 specialties, our database guarantees access to the best KOLs in the healthcare industry, supporting strategic decisions and enhancing your initiatives.

How Do We Get It?

Our database is created and maintained through a combination of secondary and primary research methodologies.

1. Secondary Research

With many years of experience in the healthcare field, we have our own rich proprietary data from various past projects. This historical data serves as the foundation for our database. Our continuous process of gathering data involves:

Analyzing historical proprietary data collected from multiple projects.
Regularly updating our existing data sets with new findings and trends.
Ensuring data consistency and accuracy through rigorous validation processes.

With extensive experience in the field, we have developed a proprietary GenAI-based technology that is uniquely tailored to our organization. This advanced technology enables us to scan a wide array of relevant information sources across the internet. Our data-gathering process includes:

Searching through academic conferences, published research, citations, and social media platforms
Collecting and compiling diverse data to build a comprehensive and detailed database
Continuously updating our database with new information to ensure its relevance and accuracy

2. Primary Research

To complement and validate our secondary data, we engage in primary research through local tie-ups and partnerships. This process involves:

Collaborating with local healthcare providers, hospitals, and clinics to gather real-time data.
Conducting surveys, interviews, and field studies to collect fresh data directly from the source.
Continuously refreshing our database to ensure that the information remains current and reliable.
Validating secondary data through cross-referencing with primary data to ensure accuracy and relevance.

Combining Secondary and Primary Research

By integrating both secondary and primary research methodologies, we ensure that our database is comprehensive, accurate, and up-to-date. The combined process involves:

Merging historical data from secondary research with real-time data from primary research.
Conducting thorough data validation and cleansing to remove inconsistencies and errors.
Organizing data into a structured format that is easily accessible and usable for various applications.
Continuously monitoring and updating the database to reflect the latest developments and trends in the healthcare field.

Through this meticulous process, we create a final database tailored to each region and domain within the healthcare industry. This approach ensures that our clients receive reliable and relevant data, empowering them to make informed decisions and drive innovation in their respective fields.