Philippines Healthcare Claims Management Market Analysis

Philippines Healthcare Claims Management Market Analysis


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The Philippines healthcare claims management market is projected to grow from $58.74 Mn in 2022 to $326.22 Mn by 2030, registering a CAGR of 23.22% during the forecast period of 2022 - 2030. The main factors driving the growth would be the rise in chronic disease and the ageing population, growing health insurance penetration and adoption of digital technologies. The market is segmented by component, type, by delivery mode and end-user. Some of the major players include Stash, Generali, Optum, Cognizant and Accenture.

ID: IN10PHHS006 CATEGORY: Healthcare Services GEOGRAPHY: Phillipines AUTHOR: Neha Davda

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Philippines Healthcare Claims Management Market Executive Summary

The Philippines healthcare claims management market is projected to grow from $58.74 Mn in 2022 to $326.22 Mn by 2030, registering a CAGR of 23.22% during the forecast period of 2022 – 2030. The Philippines had an 18.5% increase in health spending from $16.8 Bn in 2020 to $20 Bn in 2021. Its growth outpaced the 12.8% growth from the previous year.

The Philippines' healthcare sector is expanding quickly as a result of the rising demand for medical services and supplies. A growing demand for effective healthcare claim management solutions is being driven by this expansion. Many businesses are providing solutions to satisfy the expanding need in the developing industry for healthcare claim management in the Philippines. These options include everything from software platforms that automate the management and processing of claims to consultancy services that aid insurers and healthcare providers in streamlining their claims management procedures. The claim management industry is additionally aided by the government. To improve hospital claims processing, the Philippine Health Insurance Corporation (PhilHealth) has implemented a number of computer-based technologies.

Philippines Healthcare Claims Management Market

Market Dynamics

Market Growth Drivers

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

  1. Rise in chronic disease and ageing population- In the Philippines, the prevalence of chronic diseases like diabetes, hypertension, and heart disease is rising. As a result, there is an increasing need for healthcare services that can handle the complicated requirements of patients with chronic illnesses, such as claim management systems. Also, the Philippines' ageing population is getting older, which is raising the demand for insurance and healthcare services
  2. Growing health insurance penetration- The number of people and businesses choosing healthcare insurance plans is increasing in the Philippines, while health insurance penetration is also rising. As a result, more medical claims are being filed, which has increased the demand for more effective and automated claim management solutions
  3. Adoption of digital technologies- Digital technologies are being quickly embraced by the Philippines in a number of sectors, including healthcare. The rising demand for digital healthcare claim management solutions is a result of the potential benefits of using digital technology to improve efficiency, eliminate errors, and streamline operations in healthcare claim administration

Market Restraints

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

  1. Limited healthcare infrastructure- The Philippines' healthcare infrastructure is still in development, with low resources and healthcare facilities in many locations. Because of this, particularly in distant or poor locations, the adoption and implementation of healthcare claim management solutions may be constrained
  2. Limited digital literacy- Despite the Philippines' quick adoption of digital technologies, there are still some regions with low levels of digital literacy. This may make it difficult to establish digital healthcare claim management solutions and to instruct healthcare personnel on their efficient use
  3. Complex regulatory environment- The Filipino healthcare regulatory environment can be complicated, with many rules and specifications from several government bodies. Healthcare claim management system suppliers may face difficulties as a result, particularly those attempting to enter the market from abroad

Competitive Landscape

Key Players

  • Stash (PHL)- a SaaS application that connects patients and healthcare professionals by allowing for online appointment scheduling and the sharing of current records. Visitors can browse nearby doctors, search from a list of more than 10,000 doctors, and make an appointment right away. The business also functions as a Third-Party Administrator (TPA) for HMO providers, offering claims management services
  • Generali- In the Philippines, Generali has been offering life insurance solutions to both local and foreign clients since 1999. It has a proven track record, particularly in the group insurance and credit life industries
  • Optum- is committed to making healthcare delivery better, creating opportunities for clients to have better experiences, better health, and lower costs
  • Cognizant- is a global business that provides operational, digital, consulting, and medical claims processing solutions. The cloud, IoT, AI, and software engineering are the main technical fields that are changing business
  • Accenture- is a global professional services company that provides medical claims management services to clients in the Philippines and other countries. Accenture's healthcare management services include claim processing and management, analytics and reporting, fraud and abuse detection, and customer support

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.

Insights10 will provide you with the reports within 10 key parameters which are:

  1. Market Overview
  2. Market Growth Drivers & Restraints
  3. Epidemiology of Disease Type
  4. Market Segmentation
  5. Market Share
  6. Competitive Landscape
  7. Key Company Profiles
  8. Healthcare Policies & Regulatory Framework
  9. Reimbursement Scenario
  10. Factors Driving Future Growth

Based on our many years of experience, we believe that these are the parameters that are critical to decision-making for business stakeholders. Our focused approach to developing reports focused on 10 key parameters, enabled us to arrive at the name “Insights10”.

 

Stage I: Market Data Collection

Primary Interviews: We have developed a network of experts, freelancers, and researchers across countries through which we engage with local experts to gather key data points and assumptions about each market. We also engage regularly with some of the best market research agencies such as Atheneum, GuidePoint, GLG, etc. to conduct surveys and interviews, and build intelligence. We have language translators as a part of our team, who between them can cover 30+ languages allowing us to extract better local insights.

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Data Sources: We have access to multiple highly reliable free and subscription data sources. We have many years of experience to understand which sources are more dependable for what and which to prefer for the reliable and latest information. The key sources of information include the following, but are not limited to:

 

 

Stage II: Market Data Analysis and Statistical Model

Market Trends: We generally look at macro parameters and micro indicators. The macro parameters include changes in government policies, demand and supply of the market, government intervention programs, and major market share. The micro indicators are GDP growth, market size, market volume, etc. We also understand nuances specific to each country like the US, Canada, India, Germany, etc., and have worked across 60+ countries and hence not only understand global trends but how these differ by country, how payment models, market structure, cultural parameters, etc. differ in each country.

Market Sizing and Analysis: Our expert data analytics team has created various market forecast models by employing the top-down approach i.e. starting with the large overall market and segmenting different areas and the bottom-up approach i.e. starting with population and epidemiology and rolling up based on spend, etc., estimating the size of the market, and distributing among the geographic and/or product segments.

The top-down approach is mainly used for new product forecasting and the bottom-up approach is used for demand estimation of any product for different countries summed up to form the total market. We are able to round off insights and build stronger forecasts because we always do both these methods and triangulate the final numbers.

The study on the market covers the analysis of the leading geographies such as Asia-Pacific, Africa, Europe, Middle East, North America, and  Latin America for the period of 2022 to 2030. The qualitative analysis covers the industry landscape and trends, market opportunities, competitive landscape, and policy and regulatory scenario, and the quantitative analysis covers different market estimates and forecasts.

Data Triangulation & Validation:

Data triangulation of various sources and results of the research are carried out by benchmarking with reliable sources such as industry statistics, statistical databases, and company-level averages, etc.

We make sure to finalize the numbers in alignment with the market research. Firstly, our internal experts ensure thorough validation and checking to ensure accurate and precise analysis and then validation is also done using a multiple-data analysis model. Two-level validation is done and entails the finalization of the report scope and the way of representation pattern.

 

 

Stage III: Interpretation and Presentation

Analysis & Interpretation: The information gathered is then analyzed and synthesized. The second series of interviews are done if necessary to check and validate. The future opportunities are analyzed by understanding product commercialization and many other factors. It also comprises the analysis of data discrepancies observed across various data sources. Information procured from secondary and primary results is then, interpreted by considering the following parameters: (a partial list)

  • Establishing market drivers and trends
  • Analyzing the regulatory landscape to understand future growth
  • Market Segment based analysis to obtain revenue/volume
  • ​Analyzing current needs and determining penetration to estimate the market

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Data curated from the analysis and interpretation are drawn to portray all in one consolidated report.

Presentation & Reporting: The market research report is presented in different forms such as charts by using a scientific approach for easy understanding. Historic, current, and future analysis is provided for each market in terms of both value and volume. The size of the market is interpreted in the US Dollar value and the respective unit, based on the product, for volume consumption.

The foreign exchange rates are calculated on the respective dates and for the respective regions covered in the study.

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Last updated on: 23 March 2023
Updated by: Keta Vora

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