The increase in healthcare frauds is expected to drive the payer services market for tightening its security systems. Healthcare fraud includes malpractices such as individuals obtaining subsidized or fully-covered prescription pills that are actually not needed and then selling them on the black market for a profit billing by practitioners for care that they never rendered, filing duplicate claims for the same service rendered, altering the dates and modifying medical records. The healthcare industry continues to suffer losses attributed to frauds and errors.
For instance, according to the National Health Care Anti-Fraud Association, in the USA, the loss from healthcare fraud was estimated to be $300 billion in 2018. Therefore, increasing healthcare fraud in the healthcare industry is propelling the demand for rigid security systems, thereby driving the growth of the payer services market.
The global payer services market is expected to grow from $88.97 billion in 2019 to $93.9 billion in 2020 at a compound annual growth rate (CAGR) of 5.5%. The exponential growth is mainly due to the COVID-19 outbreak that has led to an increase in demand for services for medical billing and claims. The payer services market is then expected to adjust and reach $134.65 billion in 2023 from 2021 at a CAGR of 12.77%.
Increased adoption of technologically advanced products is gaining substantial popularity in the global healthcare payer services market. This has led to improved price transparency, affordable payer services, higher utilization of resources, increasing quality reach, and member satisfaction and loyalty towards the service provider.
For instance, in July 2019, Blue Shield California (BSC), with the help of Gemini Health, built up an online tool to remove out-of-pocket drug spending for individuals. The price transparency tool plots the cost data for accessible suppliers and medical clinics. The innovation recommends lower-cost choices by coordinating the current drug with lower-cost, dose-equivalent options.
The rising incidences of data breaches and loss of confidentiality are a major challenge in the payer service industry. In recent years, the healthcare sector has always been at the forefront in cases of breaching privacy and the resulting loss of confidential data. The healthcare sector accounted for 45% of data breaches in 2019, costing the sector more than $17.76 billion. Moreover, in August 2019, Avenna Healthcare in Georgia detected a phishing attack on 166,077 patients in February and began notification of a potential breach. This was caused due to improper maintenance of information leading to vulnerable cyber-attack. Rising incidences of data breaches and loss of confidentiality are thus hampering the growth of the global healthcare payer service market.
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