Wednesday, June 8th, 2016 - Global Market Insights Inc.

Healthcare Payer BPO Market size was valued at over USD 15 billion in 2015 and is anticipated to grow at over 7% CAGR from 2016 to 2023. Major drivers contributing to industry growth include increasing geriatric population and healthcare costs, shift in ICD-10 coding system, innovations and developments in IT and regulatory changes.

North America healthcare payer BPO market led the global industry with over 50% of the total revenue generated in 2015. Factors such as high number of number of public and private medical expenses, presence of strong repayment agenda, high number of claim records and favorable government policies played key role in this share. U.S. and Canada spend huge capital on medical reimbursement thus ensure strict agreement and implementation of healthcare policies.

Asia Pacific is forecast to be the most attractive region, mainly due to high economic growth, increase in public and private medical expenses, growing number of insurance services in rural and urban areas, and government policies. 

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Claims processing services was leading product sector and accounted for more than 50% of the total healthcare payer BPO market share in 2015. Increased diffusion rate of insurance coverage across the developing and developed countries is the major driver.


Rising geriatric population is anticipated to be the key driver, due to susceptibility to numerous health issues including cardiovascular diseases (CVD), respiratory disorders, cancers, eye care problems, orthopedic disorders, etc. Increasing prevalence of these diseases has led to growing amount of work for the insurance companies. In order to handle such large volume of patients and claims data, and to assure rapid turnaround time, the payer companies need to invest in infrastructure, technology and skilled personnel, leading to higher operational cost which is expected to accelerate the healthcare payer BPO market.  


Many public and private organizations outsource administrative operations to payers so as to reduce the economic burden, to increase operational efficiency, to provide universal access to healthcare, and to rationalize the complete service delivery to the clients. Outsourcing vendors establish services to provide 24 hours customer support to patients, providers, and other shareholders.  Data security and confidentiality concerns are restraints for healthcare payer BPO market growth.    

The shift from ICD-9 to ICD-10 coding system generated huge workload for the payers to upgrade their systems, train staff and thereby increased their financial burden. The ICD-9 code system had 13,000 codes, while ICD-10 code system has nearly 68,000 codes. This variation has augmented the need for medical coding, HR, accounting, skilled personnel and other technical operations, thus estimated to positively strengthen industry growth during the forecast timeframe.               


According to data reported by Centers for Medicare and Medicaid (CMS), in 2013 approximately 900,000 healthcare providers were together paid USD 80 billion as medical expenses. Of this, USD 70 billion originated from healthcare and medical services, while USD 10 billion was attributed to drugs administered.

On the basis of services offered, the industry is categorized into HR, member, claims processing, accounting and finance services. The Patient Protection and Affordable Care Act (PPACA) usually titled the Affordable Care Act (ACA) or Obamacare, is a United States centralized act that have improved access, affordability, and quality in healthcare. It provides Medicare and healthcare access to millions of Americans, and according to ObamaCare and CMS report, about 11 million people registered in 2015.

Member services sector is anticipated to show significant growth over the coming years owing to the need for value added services, upsurge in customer service requirements, and high competition to register new customers and retain existing clients.

Key participants in the industry are Xerox Corporation, Hinduja Global Solutions, DSM Pharma, Accenture, Cognizant Technology Solutions, Wipro, Genpact, EXLService, Hewlett-Packard, Catalent, and HCL. These corporations accumulate significant share owing to their robust capability in BPO delivering functions, technology platforms, and the ability to meet high regulatory and compliance values of the U.S. and European regions. Other prominent companies contributing to global healthcare payer BPO market share are Lonza, Inventive, BoehringerIngelheim, GeBBS Healthcare, Quintiles and Medusind.

Claims processing services was leading product sector and accounted for more than 50% of the total healthcare payer BPO market share in 2015. Increased diffusion rate of insurance coverage across the developing and developed countries is the major driver.


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