Japan Healthcare Claims Management Market Analysis

Japan Healthcare Claims Management Market Executive Summary

The Japan healthcare claims management market is projected to grow from $1.66 Bn in 2022 to $9.22 Bn by 2030, registering a CAGR of 12.2% during the forecast period of 2022 - 2030. In Japan, healthcare costs rose from $4,256 to $4,360 per person in 2018, while they fell from 10.75% to 10.74% of GDP in 2019. Japan spends more on healthcare than other industrialised countries in the globe as a whole.

The procedure of processing and managing claims for medical services rendered to patients is referred to as healthcare claim management in the Japanese market. The Japanese government has implemented a number of laws and regulations to enhance the procedure after realising the value of effective healthcare claim management. For instance, to standardise the billing and reimbursement process for medical services, the government has introduced the Diagnosis Procedure Combination (DPC) system. Success has been achieved by the DPC system in lowering the administrative burden on healthcare providers and enhancing the precision and effectiveness of the claim management procedure.

 In Japan, medical institutions report health insurance claims data to health insurance unions in order to claim insurance-covered treatment charges. Each patient receives one monthly health insurance claim. Medical costs are specifically stated in relation to the medical services rendered and are also covered by health insurance claims. The vast majority of health insurance claims, particular health examinations, specific health guidance data, etc. of all inhabitants are gathered in the NDB, a national database. Based on the "Act on Guarantee of Medical Care for Older Persons," which was put into effect in April 2008, NDB was created to carry out the surveys and analyses required for creating, carrying out, and evaluating a medical expenses optimization plan.

Market Dynamics

Market Growth Drivers

The Japanese healthcare claims management market is expected to be driven by factors such as:

1. Aging population- With a median age of 48, the population of Japan is among the oldest in the world. As a result, there is now a higher demand for healthcare services, which has raised the number of medical claims. As healthcare providers look for more effective and efficient ways to handle the rising number of claims, the market for healthcare claims management is anticipated to expand
2. Government initiatives- The Japanese government has launched many programmes, such as DPC, to improve the efficiency of the healthcare claims management process. The government has implemented the electronic health record (EHR) system, which has simplified the claims management procedure by facilitating easier access to patient data by healthcare professionals
3. Technological advancements- Technological developments, such as the processing of claims using artificial intelligence (AI) and machine learning (ML), are driving the healthcare claims management market in Japan. These technologies are improved patient outcomes while lowering an administrative load and enhancing the accuracy and efficiency of the claims management process
4. Increasing healthcare expenditure- The ageing population in Japan is likely to contribute to one of the highest healthcare expenses worldwide. As healthcare providers look to manage their claims more effectively and economically, rising healthcare costs are fueling the market for healthcare claims management

Market Restraints

The following factors are expected to limit the growth of the healthcare claims management market in Japan:

1. Complex regulatory environment- Healthcare providers and software vendors may find it difficult to navigate the heavily regulated healthcare environment in Japan. This may restrict the uptake of new technology and hinder the market's expansion for healthcare claims management
2. High implementation costs- For healthcare providers, implementing new claims management software and technology can be expensive. This may restrict the uptake of innovative technology and hinder commercial expansion
3. Limited interoperability- It can be difficult to integrate new claims management technology with current systems in Japan because there is still a lack of interoperability across various healthcare IT systems. This may restrict the uptake of innovative technology and hinder commercial expansion

Competitive Landscape

Key Players

• NTT Data (JPN)- provides claim processing services that advance through application modernization. Provide established workflows for common claim processes together with a thorough list of KPIs for both the overall process and each individual subprocess. Secondly, our process optimization services assist you in lowering costs, enhancing transactions, and reducing risk using open, architecture-neutral solutions that are independent of the platform. This comprises an online claims portal with first notice of loss and claims progress tracking, a process library of efficient claim procedures with established workflows, and thorough testing of claim functionality for all product lines
• iChain (JPN)- Japanese leading InsurTech firm iChain is situated in Tokyo and innovates the insurance sector using Blockchain technology. With the help of a smartphone, people can now manage their insurance policies digitally instead of on paper. With the motto "Making the world a better place," iChain realises the importance of making insurance claims without hesitation
• Cognizant- a multinational business that provides operational, digital, and technical assistance, as well as tools for processing medical claims. The cloud, IoT, AI, and software engineering are the main technological topics that are revolutionising business
• Accenture- a multinational professional services firm that offers clients in Italy and other nations services for managing medical claims. Customer support, fraud and abuse detection, analytics and reporting, as well as claims processing and management, are all included in Accenture's healthcare management services
• Genpact- segmentation, fast-track claims, and claims setup are all managed by the comprehensive claims servicing platform genpact claims manager

Notable News

October 2022- The NelsonHall 2022 NEAT Report for Salesforce Services has selected NTT DATA, a leader in global digital business and IT services, a Leader. For two market sectors, including total Salesforce services and services linked to Salesforce's MuleSoft integration and API platform, the report positioned NTT DATA in the Leaders quadrant.