Healthcare Fraud Analytics Market Size, Share & Trends by 2027
2019 年医疗保健欺诈分析市场价值为 13.3109 亿美元,预计到 2027 年将达到 87.0773 亿美元;预计 2020 年至 2027 年的复合年增长率为 27.0%。
医疗保健欺诈是一种白领犯罪,包括提出不诚实的医疗保健索赔以牟利。大多数医疗保健欺诈是由有组织犯罪集团和少数欺诈性医疗保健提供者实施的。最常见的医疗保健欺诈类型包括对更昂贵的服务或程序开具账单、歪曲未涵盖的治疗、保险欺诈等。全球医疗保健欺诈分析市场的增长归因于所有行业的欺诈案件数量不断增加,以及美国健康保险行业的增长。然而,对医疗保健欺诈分析的担忧是阻碍市场增长的主要因素。
预计全球医疗欺诈分析市场将在疫情后出现大幅增长。由于封锁、旅行禁令和企业停业,COVID-19 影响了各国的经济和行业。COVID-19 危机使许多国家的公共卫生系统不堪重负,凸显了对卫生系统进行可持续投资的强烈需求。随着 COVID-19 疫情的进展,预计医疗行业的增长将出现下降。由于对体外诊断产品的需求增加以及全球研发活动的增加,生命科学领域蓬勃发展。然而,由于手术数量减少以及设备采购推迟或延长,医疗技术和成像领域的销售额正在下降。此外,预计医疗专业人员的虚拟咨询将成为疫情后主流的医疗服务模式。随着远程医疗改变医疗服务,数字医疗将在未来几年继续蓬勃发展。此外,临床试验中断以及随后的药物上市延迟也有望为未来的完全虚拟试验铺平道路。 mRNA 等新技术预计将会出现并改变制药行业,未来几年市场也有望见证更多的垂直整合和合资企业。
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医疗保健欺诈分析市场:
复合年增长率(2019 - 2027 年) (2019 - 2027)27.0%- 2019 年市场规模
13.3 亿美元 - 2027 年市场规模
87.1 亿美元
市场动态
- 財政部
- 財政部
- 財政部
- 財政部
- 財政部
- 財政部
- 財政部
- 財政部
- 財政部
关键人物;主力;重要一员
- Conduent 公司
- DXC 技术
- Scioinspire 公司
- 费埃哲
- Optum 公司
- SAS 研究所
- Pondera 解决方案
- Lexisnexis 风险解决方案
- 白哈泰
区域概况
- 北美
- 欧洲
- 亚太
- 南美洲和中美洲
- 中东和非洲
市场细分
- 预测分析
- 描述性分析
- 规范分析
- 按需交付模式
- 按需交付模式
- 保险索赔审查
- 药房账单滥用
- 付款诚信
- 医疗身份盗窃
- 其他应用
- 政府机构
- 私人保险支付者
- 第三方服务提供商
- 雇主
- 示例 PDF 通过定性和定量分析展示了内容结构和信息的性质。
市场洞察
美国健康保险业蓬勃发展,推动全球医疗欺诈分析市场增长
健康保险欺诈是针对保险公司或代理人实施的蓄意欺骗,目的是获取经济利益。欺诈行为发生在不同的交易点,实施者包括申请人、保单持有人、第三方索赔人或为索赔人提供服务的医疗保健专业人员。有时,保险代理人以及公司员工也可能实施保险欺诈。常见的健康保险欺诈包括操纵合法索赔、夸大保险申请中的事实、提交从未发生的疾病或伤害索赔以及捏造事故。
在美国,有超过 900 家健康保险公司提供医疗保险。此外,美国拥有医疗保险的人数也很高。根据《2018 年美国健康保险覆盖率》报告,2018 年,约 91.5% 的人口拥有医疗保险。该报告还提到,2018 年,美国私人医疗保险覆盖率高于公共医疗保险覆盖率,约 67.3% 的人口拥有私人医疗保险,34.4% 的人口拥有公共医疗保险。在子类型中,雇主提供的保险是最常见的医疗保险覆盖率,占总人口的 55.1%。
由于健康保险行业的不断发展和健康保险欺诈数量的增加,预计预测期内对医疗保健欺诈分析解决方案的需求将会增加。
基于解决方案的见解
在解决方案方面,全球医疗欺诈分析市场分为预测分析、描述分析和规范分析。2019 年,预测分析领域占据了最大的市场份额。此外,预计同一领域在预测期内的复合年增长率最高。
基于交付模式的洞察
根据交付方式,全球医疗欺诈分析市场分为本地交付模式和基于云的交付模式。本地交付模式部分在 2019 年占据了最大的市场份额。然而,基于云的交付模式部分预计在预测期内的复合年增长率最高。
基于应用的洞察
根据应用,全球医疗欺诈分析市场细分为保险索赔审查、药房账单滥用、支付完整性、医疗身份盗窃和其他应用。保险索赔部分在 2019 年占据了最大的市场份额。此外,预计同一部分在预测期内的复合年增长率最高。
基于最终用户的洞察
就最终用户而言,全球医疗欺诈分析市场分为政府机构、私人保险支付方、第三方服务提供商和雇主。政府机构部门在 2019 年占据了最大的市场份额,预计该部门在预测期内的复合年增长率最高。
全球医疗保健欺诈分析市场参与者正在采用产品发布和扩展策略来满足全球不断变化的客户需求,这也使他们能够在全球范围内维护自己的品牌名称。
医疗保健欺诈分析市场报告范围
报告属性 | 细节 |
---|---|
2019 年市场规模 | 13.3亿美元 |
2027 年市场规模 | 87.1亿美元 |
全球复合年增长率(2019 - 2027) | 27.0% |
历史数据 | 2017-2018 |
预测期 | 2020-2027 |
涵盖的领域 | 按解决方案
|
覆盖地区和国家 | 北美
|
市场领导者和主要公司简介 |
|
- 示例 PDF 通过定性和定量分析展示了内容结构和信息的性质。
全球医疗保健欺诈分析市场 – 按解决方案
- 预测分析
- 描述性分析
- 规范分析
全球医疗保健欺诈分析市场 – 按交付方式划分
- 本地交付模式
- 基于云的交付模型
全球医疗保健欺诈分析市场 – 按应用划分
- 保险索赔审查
- 药房账单滥用
- 付款诚信
- 医疗身份盗窃
- 其他应用
全球医疗保健欺诈分析市场 – 按最终用户划分
- 政府机构
- 私人保险支付者
- 第三方服务提供商
- 雇主
全球医疗保健欺诈分析市场 – 按地区划分
北美
- 我们
- 加拿大
- 墨西哥
欧洲
- 法国
- 德国
- 意大利
- 英国
- 西班牙
- 欧洲其他地区
亚太地区 (APAC)
- 中国
- 印度
- 韩国
- 日本
- 澳大利亚
- 亚太地区其他地区
中东和非洲 (MEA)
- 南非
- 沙特阿拉伯
- 阿联酋
- MEA 其他地区
南美洲和中美洲(SCAM)
- 巴西
- 阿根廷
- 其余的骗局
公司简介
- Conduent 公司
- DXC 技术
- Scioinspire 公司
- Optum 公司
- SAS 研究所
- Pondera 解决方案
- Lexisnexis 风险解决方案
- 费尔艾萨克公司 (FICO)
- Cotiviti 公司
- 白哈泰
Report Coverage
Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends
Segment Covered
This text is related
to segments covered.
Regional Scope
North America, Europe, Asia Pacific, Middle East & Africa, South & Central America
Country Scope
This text is related
to country scope.
Frequently Asked Questions
As per the Global Health Care Anti-Fraud Network, each year approximately US$ 260 billion (180 billion euros) or about 6 percent of the global total health care expenditure is lost to fraud. The number of healthcare frauds is increasing in the US. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US $300 billion.
Healthcare fraud is a kind of white-collar crime that includes the filing of dishonest health care claims to turn a profit. The majority of health care fraud is committed by organized crime groups and a small minority of fraudulent health care providers. The most common types of health care fraud include billing for more expensive services or procedures, misrepresenting non-covered treatments, insurance frauds, and others.
factors such as rising number of healthcare fraudulent cases across the globe and growing health insurance industry are expected to boost the market growth over the years. Moreover, growing hospital industry is likely to have a positive impact on the growth of the market in coming years.
The List of Companies – Global Healthcare Fraud Analytics Market
- Conduent Inc.
- DXC Technology
- Scioinspire, Corp.
- FICO
- Optum, Inc.
- SAS Institute
- Pondera Solutions
- Lexisnexis Risk Solutions
- Whitehatai
- Cotiviti, Inc.
The Insight Partners performs research in 4 major stages: Data Collection & Secondary Research, Primary Research, Data Analysis and Data Triangulation & Final Review.
- Data Collection and Secondary Research:
As a market research and consulting firm operating from a decade, we have published and advised several client across the globe. First step for any study will start with an assessment of currently available data and insights from existing reports. Further, historical and current market information is collected from Investor Presentations, Annual Reports, SEC Filings, etc., and other information related to company’s performance and market positioning are gathered from Paid Databases (Factiva, Hoovers, and Reuters) and various other publications available in public domain.
Several associations trade associates, technical forums, institutes, societies and organization are accessed to gain technical as well as market related insights through their publications such as research papers, blogs and press releases related to the studies are referred to get cues about the market. Further, white papers, journals, magazines, and other news articles published in last 3 years are scrutinized and analyzed to understand the current market trends.
- Primary Research:
The primarily interview analysis comprise of data obtained from industry participants interview and answers to survey questions gathered by in-house primary team.
For primary research, interviews are conducted with industry experts/CEOs/Marketing Managers/VPs/Subject Matter Experts from both demand and supply side to get a 360-degree view of the market. The primary team conducts several interviews based on the complexity of the markets to understand the various market trends and dynamics which makes research more credible and precise.
A typical research interview fulfils the following functions:
- Provides first-hand information on the market size, market trends, growth trends, competitive landscape, and outlook
- Validates and strengthens in-house secondary research findings
- Develops the analysis team’s expertise and market understanding
Primary research involves email interactions and telephone interviews for each market, category, segment, and sub-segment across geographies. The participants who typically take part in such a process include, but are not limited to:
- Industry participants: VPs, business development managers, market intelligence managers and national sales managers
- Outside experts: Valuation experts, research analysts and key opinion leaders specializing in the electronics and semiconductor industry.
Below is the breakup of our primary respondents by company, designation, and region:
Once we receive the confirmation from primary research sources or primary respondents, we finalize the base year market estimation and forecast the data as per the macroeconomic and microeconomic factors assessed during data collection.
- Data Analysis:
Once data is validated through both secondary as well as primary respondents, we finalize the market estimations by hypothesis formulation and factor analysis at regional and country level.
- Macro-Economic Factor Analysis:
We analyse macroeconomic indicators such the gross domestic product (GDP), increase in the demand for goods and services across industries, technological advancement, regional economic growth, governmental policies, the influence of COVID-19, PEST analysis, and other aspects. This analysis aids in setting benchmarks for various nations/regions and approximating market splits. Additionally, the general trend of the aforementioned components aid in determining the market's development possibilities.
- Country Level Data:
Various factors that are especially aligned to the country are taken into account to determine the market size for a certain area and country, including the presence of vendors, such as headquarters and offices, the country's GDP, demand patterns, and industry growth. To comprehend the market dynamics for the nation, a number of growth variables, inhibitors, application areas, and current market trends are researched. The aforementioned elements aid in determining the country's overall market's growth potential.
- Company Profile:
The “Table of Contents” is formulated by listing and analyzing more than 25 - 30 companies operating in the market ecosystem across geographies. However, we profile only 10 companies as a standard practice in our syndicate reports. These 10 companies comprise leading, emerging, and regional players. Nonetheless, our analysis is not restricted to the 10 listed companies, we also analyze other companies present in the market to develop a holistic view and understand the prevailing trends. The “Company Profiles” section in the report covers key facts, business description, products & services, financial information, SWOT analysis, and key developments. The financial information presented is extracted from the annual reports and official documents of the publicly listed companies. Upon collecting the information for the sections of respective companies, we verify them via various primary sources and then compile the data in respective company profiles. The company level information helps us in deriving the base number as well as in forecasting the market size.
- Developing Base Number:
Aggregation of sales statistics (2020-2022) and macro-economic factor, and other secondary and primary research insights are utilized to arrive at base number and related market shares for 2022. The data gaps are identified in this step and relevant market data is analyzed, collected from paid primary interviews or databases. On finalizing the base year market size, forecasts are developed on the basis of macro-economic, industry and market growth factors and company level analysis.
- Data Triangulation and Final Review:
The market findings and base year market size calculations are validated from supply as well as demand side. Demand side validations are based on macro-economic factor analysis and benchmarks for respective regions and countries. In case of supply side validations, revenues of major companies are estimated (in case not available) based on industry benchmark, approximate number of employees, product portfolio, and primary interviews revenues are gathered. Further revenue from target product/service segment is assessed to avoid overshooting of market statistics. In case of heavy deviations between supply and demand side values, all thes steps are repeated to achieve synchronization.
We follow an iterative model, wherein we share our research findings with Subject Matter Experts (SME’s) and Key Opinion Leaders (KOLs) until consensus view of the market is not formulated – this model negates any drastic deviation in the opinions of experts. Only validated and universally acceptable research findings are quoted in our reports.
We have important check points that we use to validate our research findings – which we call – data triangulation, where we validate the information, we generate from secondary sources with primary interviews and then we re-validate with our internal data bases and Subject matter experts. This comprehensive model enables us to deliver high quality, reliable data in shortest possible time.