A sample report on
Canada Healthcare
Claims Management
Market
Includes Market Size, Market Segmented by Types
and Key Competitors (Data forecasts from 2022 – 2030F)
www.insights10.com
This report presents a strategic analysis of the Canada Healthcare Claims Management Market and a forecast for its development in the medium and long term. It provides a comprehensive overview of the market value, dynamics, segmentation, main players, growth and demand drivers, challenges & future outlook, etc. This is one of the most comprehensive reports about the Canada Healthcare Claims Management Market, and offers unmatched value, accuracy, and expert insights
Report Scope
Report Attribute
Details
Number of Pages
70-80
Base Year for Estimation
2022
Forecast Period
2023-2030
Market Overview, Revenue Forecast, Market Segmentation, Growth Factors and Trends, Report Coverage
Competitive Landscape, Key Company Profiles, Government Policies, Regulatory Landscape, Reimbursement Scenario
Quantitative Units
Revenue in USD Million/Billion (Mn/Bn)
Research Approach
Secondary Research (60%), Primary Research (40%)
Click on the icon to know the detailed methodology
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 3
Table of Content
CONTENT
PG. NO.
1. Healthcare Claims Management Overview
08-24
1.1. Healthcare Claims Process In Canada
1.2. Canada Overview
1.3. Economic Overview: Canada
1.4. Healthcare Claims Management Market in Canada
1.5. Healthcare Services Market in Canada
1.6. Healthcare Scenario in Canada
1.7. Health Insurance Coverage: Canada
1.8. Budget of the Government for Public Insurance
1.9. Mergers and Acquisitions
2. Market Size and Forecasting
25-33
2.1 Market size and forecasts (Excel and Methodology)
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 4
Table of Content
CONTENT
PG. NO.
2.2. Market Segmentation
2.2.1. By Service Type
2.2.2. By Deployment Mode
2.2.3. By End User
2.2.1. By Component
2.2.2. By Organization Size
2.2.3. By Mode of Delivery
3. Market Dynamics
34-38
3.1. Market Growth Drivers
3.1.1. Canada Healthcare Claims Management Market Driver 1
3.1.2. Canada Healthcare Claims Management Market Driver 2
3.1.3. Canada Healthcare Claims Management Market Driver 3
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 5
Table of Content
CONTENT
PG. NO.
3.2. Market Restraints
3.2.1. Canada Healthcare Claims Management Market Restraint 1
3.2.2. Canada Healthcare Claims Management Market Restraint 2
3.2.3. Canada Healthcare Claims Management Market Restraint 3
4. Competitive Landscape
39-49
4.1. Major Market Share
4.2. Key Company Profile
4.2.1. Accenture
4.2.2. IBM Corporation
4.2.3. McKesson Corporation
4.2.4. Infosys Limited
4.2.5. Cognizant
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 6
Table of Content
CONTENT
PG. NO.
4.2.6. TELUS Health
4.2.7. Optum, Inc.
4.2.8. CGI Group Inc.
4.2.9. Change Healthcare
4.2.10. Allscripts Healthcare
5. Reimbursement Scenario
50-55
5.1. Reimbursement Regulation
5.2. Reimbursement Process for Diagnosis
5.3. Reimbursement Process for Treatment
6. Methodology & Scope
56-61
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 7
Canada Healthcare Claims Management Market Analysis
1. Healthcare Claims Management Overview
1.1 Healthcare Claims Process In Canada
Here are the main parts of the healthcare claim process in Canada: 1.
Patient Registration: Similar to other healthcare systems, patients need to register with their healthcare provider and provide their personal information, including their provincial health insurance number, which grants them access to publicly funded healthcare services 2.
Service Documentation: Healthcare providers document the services provided to the patient, including diagnoses, procedures, treatments, medications, and other relevant information. This documentation is essential for accurate billing and claim submission 3.
Claim Creation: Based on the service documentation, a claim is created using specific billing codes and other relevant information. In Canada, the billing codes used for procedures and services are typically based on the Canadian version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) and the Canadian Classification of Health Interventions (CCI) 4.
Claim Submission: The claim is submitted to the respective provincial or territorial health authority or an intermediary organization responsible for processing claims on behalf of the government. Each province or territory may have its own electronic or paper-based claim submission processes 5.
Adjudication: The provincial or territorial health authority reviews the claim to determine if the services provided are covered under the publicly funded healthcare system. This process involves assessing the submitted documentation and comparing it against the province or territory's guidelines and policies
6.
Payment or Denial: After the claim is adjudicated, the health authority will either approve the claim and provide payment to the healthcare provider or deny the claim if it does not meet the necessary requirements. Denials can occur for various reasons, such as incomplete documentation or services not meeting the eligibility criteria
7.
Patient Billing: If there are any patient fees or costs not covered by the publicly funded healthcare system, such as copayments or deductibles, the healthcare provider may bill the patient directly for those amounts 8.
Claim Follow-Up: In cases of denials or payment discrepancies, healthcare providers may need to follow up with the health authority to resolve any issues and ensure proper reimbursement
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 9
1.1 Healthcare Claims Administration In Canada (continued) Outsourcing options for health claims administrations Type Of Stakeholders In the
Healthcare Claim Management
Market
The manual process of receiving,
recording, handling and processing of
➢ Healthcare Providers
BPO
claims (e.g., back and front office
outsourcing, knowledge process
Business
Process
outsourcing)
➢ Insurance Payers
Outsourcing
Building and maintaining applications
➢ Third-Party Administrators (TPAs)
ADM
and design IT processes (e.g.,
Application
production support, security and
Development and
controls, application development and
➢ Government Healthcare Agencies
Maintenance
support
➢ Medical Billing Companies
ITI
Building the physical capabilities to run
➢ Employers
applications and house data (e.g., Data
IT Infrastructure
Centers, Servers, Networks, etc.)
➢ Healthcare Clearinghouses
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 10
1.2 Global Top 10 Digital Health Trends in 2023 and Start Ups Digital Health
Healthcare
Digital
Analytics
Therapeutics
Patient
Cloud Healthcare
Engagement
Electronic Health
Home Healthcare
Records
Medical
Digital
Wearables
Biomarkers
Remote Patient
Mobile Health
Monitoring
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 11
1.2 Overview of Healthcare Claims Management Market in the World (continued)
Canada
Europe
Market
~Revenue to reach
~$XX Bn
$XX Bn by 2027
Asia
-Fastest CAGR
North America
~ Market Size of
$93.5 Bn
Africa
~Market Size of
$XX Bn
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 12
1.3 Canada Overview
▪
Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
report
▪
In this section you will get an
understanding of the demographics of the
country/region, which includes the
38 Mn
$2.090 trillion
population, GDP, healthcare expenditure
and other details related to the topic
Is the population of
GDP
Canada
▪
In order to obtain access to all of the
information that you are seeking, you will
need to purchase the final report
▪
Final report will be comprehensive and
40.2
$52,722
detailed, and it will include data, analysis,
Is the median age
per capita
trends, and other relevant information
in Canada
related to the topic or subject matter of
interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 13
1.3 Economic Overview: Canada
Population of Canada, (2020-2030)
GDP of Canada, (2020-2030)
XX
XX
XX
XX
2020
2021
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
Population Split (2023)
▪
In this section you will get an understanding of the demographics of the country/region, which includes the population, GDP, By Gender
By Age Group
healthcare expenditure and other details related to the topic
▪
In order to obtain access to all of the information that you are 0-14
seeking, you will need to purchase the final report
15-24
Female
Male
▪
Final report will be comprehensive and detailed, and it will 51%
49%
25-54
include data, analysis, trends, and other relevant information 55-64
related to the topic or subject matter of interest
65+
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 14
1.4 Digital Health Overview in Canada
Digital Health Services Survey: At a glance
▪
Please be aware that this sample report
72%
58%
42%
is intended to provide you with a brief
receive medical
have made an
access websites, mobile
overview of the kind of information and
advice from a health
appointment
applications, or interactive online
analysis that will be presented in the
care provider by
electronically
tools and services designed to
final report
telephone
help support monitor their health
▪
In this section you will get an
89%
60%
69%
understanding of the topic, which
of patients find it
find it easy to receive
find it easy to receive care through
includes the prevalence of the disease,
easy to receive care
care through video
secure messaging
the application of medical devices, new
via telephone
technology, and other details related to
the topic in Canada
70%
91%
69%
▪
In order to obtain access to all of the
of physicians believe
of Canadians are
find it easy to receive care through
information that you are seeking, you
that virtual care
satisfied with the
secure messaging
will need to purchase the final report
improves patient
quality of virtual care
▪
Final report will be comprehensive and
access and enables
detailed, and it will include data,
both quality and
analysis, trends, and other relevant
efficient care
information related to the topic or
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 15
1.5 Healthcare Services in Canada
Canada Healthcare Services Market Forecast, 2022-2030 (in $Bn) 620
639
658
677
698
719
740
763
785
2022
2023F
2024F
2025F
2026F
2027F
2028F
2029F
2030F
▪
Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will be presented in the final report
▪
In this section you will get an understanding of the overall Healthcare Services market in Canada, which includes the market size, current trends and other details related to the topic
▪
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
▪
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 16
1.6 Healthcare Scenario in Canada
Canada's healthcare system is often called a publicly funded, universal healthcare system. Here is an overview of the healthcare scenario in Canada:
1.
Universal Coverage: Canada has a publicly funded healthcare system known as Medicare, which provides universal coverage for medically necessary hospital and physician services. This means that all Canadian citizens and permanent residents have access to essential healthcare services without direct payment at the point of service 2.
Provincial/Territorial Responsibility: Healthcare in Canada is primarily administered at the provincial and territorial level, resulting in some variations in healthcare delivery across different regions. Each province and territory is responsible for managing and delivering healthcare services within the framework of the Canada Health Act
3.
Primary Healthcare: Primary healthcare serves as the first point of contact for Canadians seeking medical care. It includes services provided by family physicians, nurse practitioners, and other healthcare professionals. Primary care focuses on preventive care, health promotion, and the management of common illnesses
4.
Hospital Care: Hospital care is provided to Canadians through publicly funded hospitals. Hospital services include emergency care, surgeries, diagnostic tests, and specialized treatments. Access to hospital care is typically based on medical necessity, urgency, and availability of resources
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 17
1.6 Healthcare Scenario in Canada (continued)
Canada's healthcare system is often called a publicly funded, universal healthcare system. Here is an overview of the healthcare scenario in Canada:
5.
Prescription Medications: While hospital and physician services are covered under Medicare, prescription medications are not universally covered. The provision of prescription drug coverage varies by province, with some provinces offering public drug insurance programs to help subsidize the cost of medications for certain populations, such as seniors or low-income individuals 6.
Wait Times: Wait times for certain medical procedures and specialist consultations have been a concern in the Canadian healthcare system. Efforts have been made to reduce wait times through initiatives such as targeted funding, improved coordination, and innovative models of care delivery
7.
Private Healthcare: While Canada's healthcare system is predominantly publicly funded and publicly delivered, private healthcare also has a role. Private clinics and facilities exist, providing services that are not covered by the public system, such as cosmetic surgery or elective procedures. However, access to private healthcare cannot be used to bypass or expedite access to publicly funded care 8.
Healthcare Expenditure: Healthcare expenditure in Canada is funded through a combination of federal, provincial, and territorial tax revenues. The federal government provides financial transfers to the provinces and territories to support healthcare delivery. Canadians also have the option to purchase private health insurance for additional coverage, such as prescription drugs, dental care, or vision care Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 18
1.6 Healthcare Scenario: Patient Journey
Presentation
Diagnosis
Treatment
Follow up
Confirmatory Diagnosis
Complete blood count
Prevention and management of
(evaluate number &
crisis:
quality of RBCs, Hb &
• For VOC and Splenic
• Long term follow-up is required for
WBCs)
patients with SCD
Initial Diagnosis
Sequestration: HU, Endari,
Adakveo, Oxbryta
• Annual assessment: CBC and
A suspected diagnosis is
Imaging (confirm bone
• For infections: Antibiotics,
reticulocyte count, iron status, liver
usually made, based on
related changes or
Vaccines
and renal function tests, urinalysis,
physical examination and
respiratory problems)
Prenatal screening/
LDH, vitamin D level and
detailed patient and family
Neonatal screening
Bacterial cultures of
neurocognitive assessment
history
blood, sputum, urine,
• ESOD (End Stage Organ Damage)
stool (detect any
Prevention and management of
evaluation starting from age 7
infection)
complications:
• Yearly Transcranial Doppler test to
determine risk of stroke
Genetic testing (detect
• Stroke: Chronic transfusions, HU
the type of SCD)
sr
PCP, pediatrician, neonatologist,
ed
endocrinologist, cardiologist,
l
PCP, paediatrician,
PCP, pediatrician, medical geneticist,
o
neonatologist,
PCP, pediatrician, medical geneticist,
hematologist, orthopedist, psychologist
cardiologist, hematologist,
haematologist and genetic
hematologist, gynecologist and pathologist
and psychiatrist
endocrinologist, psychologist and
counsellor
psychiatrist
Depending on the organ complications,
Stakeh
the treatment involves different
specialists at different times
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 19
1.7 Health Insurance Coverage: Canada
% of People by Type of Health Insurance Coverage
Number of People By Health Insurance Coverage
(2021)
Coverage Type
2020
2021
Change %
Uninsured
8.3
Total
327,521
328,074
With health insurance
91.7
Any health plan
299,230
300,887
0.4
Any private plan
217,896
216,366
–0.6
Any private plan
66.0
Employment-based
178,737
178,285
–0.2
Employment-based
54.3
Direct-purchase
10.2
Direct-purchase
33,869
33,555
–0.1
Marketplace
3.5
Marketplace coverage
10,924
11,389
0.1
TRICARE
2.5
TRICARE
9,165
8,299
–0.3
Any public plan
112,925
117,095
1.2
Any public plan
35.7
58,541
60,226
0.5
18.4
58,778
61,940
0.9
18.9
2,967
3,151
0.1
1.0
Uninsured
28,291
27,187
–0.4
▪
Canada has a universal healthcare system, which means that all Canadian citizens and permanent residents are eligible for medically necessary healthcare services. This coverage is provided through the provincial and territorial healthcare plans
▪
While the public healthcare system provides coverage for medically necessary services, certain healthcare services and items are not covered. This includes prescription drugs outside of the public drug programs, dental care, vision care, and other paramedical services
▪
Many Canadians supplement their coverage through private health insurance plans offered by employers or purchased individually Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 20
1.8 Budget of Canada Government for Public Insurance
Proposed Budget By Category
Outlays
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2022-31
In Billions Of Dollars
$769
$709
$766
$841
$840
$947
$1,014
$1,085
$1,227
$1,178
$1,325
$1,412
$10,633
Public
Insurence
As % Of GDP
3.7%
3.2%
3.3%
3.4%
3.3%
3.6%
3.7%
3.8%
4.1%
3.8%
4.1%
4.2%
3.7%
▪
National Health Expenditures (NHE) grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP)
▪
Public Insurence spending grew 8.4% to $900.8 billion in 2021, or 21% of total NHE
▪
Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28% of total NHE
▪
Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10% of total NHE
▪
Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14% of total NHE
▪
Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020
▪
Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020
▪
Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020
▪
Largest shares of total health spending were sponsored by the federal government (34%) and the households (27%). The private business share of health spending accounted for 17% of total health care spending, state and local governments accounted for 15%, and other private revenues accounted for 7%
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 21
1.9 Mergers and Acquisitions
RCM M&A Deal Value Trend ($Bn)
RCM M&A Deal Volume Trend
$16.7
112
107
107
110
89
$11.7
82
$10.5
$7.7
$6.8
$6.0
1H 2020
2H 2020
1H 2021
2H 2021
1H 2022
2H 2022
1H 2020
2H 2020
1H 2021
2H 2021
1H 2022
2H 2022
Buyer Composition: Strategic Vs Financial (2020)
Buyer Type by Deal Size
41%
41%
42%
39%
($Mn)
59%
59%
58%
61%
Strategic Buyers
Financial Buyers
$0- $25
$25-$50
$50-$100
$100+
57% of the total deal volume are done by strategic buyers and the rest 43% are done by financial buyers in 2020
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 22
1.9 Digital Health Market News (continued)
Global News
Company Name
Year
Key Pointers
▪
DeliverHealth, a global provider of technology-enabled solutions for hospitals, health systems, and group practices, launched its partner program built to unify point solutions in healthcare and clear the way for essential, resilient In March 2022,
connections among providers, clinicians, and patients
▪
Patform allows for frictionless access and effective workflows to apply purpose-built, explainable AI with the needed human-in-the-loop flexibility that delivers speed to value
DeliverHealth
▪
Blessing Health System, an integrated rural health system, selected Biofourmis, a virtual care and digital therapeutics provider, to launch its home hospital March 2022
services
▪
Biofourmis is supporting the health system with its turnkey, end-to-end, home hospital solution for participation in the Rural Home Hospital project.
Blessing Health System
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 23
1.9 Mergers and Acquisitions (continued)
Latest Deals In Canada
Amount /
Company Name
Type
Year
Key Pointers
Duration
Merger
March 2023
Merger
Jan 2023
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 24
Canada Healthcare Claims Management Market Analysis
2. Market Size and Forecasting
2.1 Market size and forecasts (Excel and Methodology) Canada Healthcare Claims Management Market Forecast, 2022-2030
Click on the icon to know the
methodology and assumption
(in $Bn)
▪
Please be aware that this sample report
XX
is intended to provide you with a brief
XX
overview of the kind of information and
analysis that will be presented in the
final report
▪
In this section you will get an
understanding of the overall Canada
Healthcare Claims Management
Market, which includes the market size,
2022
2023F
2024F
2025F
2026F
2027F
2028F
2029F
2030F
current trends and other details related
2023
2024
2025
2026
2027
2028
2029
2030
to the topic
Major Markets Patient
2.74
2.82
2.90
2.94
2.98
3.02
3.07
3.12
▪
In order to obtain access to all of the
(Mn)
information that you are seeking, you
will need to purchase the final report
Canada Patient Size (Bn)
0.51
0.61
0.68
0.69
0.70
0.71
0.72
0.73
▪
Final report will be comprehensive and
% of US Patients
18.75% 21.70% 23.56% 23.45% 23.42% 23.39% 23.34% 23.45%
detailed, and it will include data,
Global Market Size (Bn $)
3,620
3,780
3,950
4,128
4,314
4,508
4,711
4,937
analysis, trends, and other relevant
information related to the topic or
Canada Market Size (Bn
61
74
84
87
91
95
99
106
subject matter of interest
$)
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 26
2.2 Snapshot of Healthcare Claims Management Market Segmentation By Deployment
By Organization
By Mode of
By Service Type
By End User
By Component
Mode
Size
Delivery
Claims
Hospitals and
Integrated
On-Premises
Software
SMEs
Processing
Clinics
Solutions
Claims Denial
Insurance
Large
Standalone
Cloud-Based
Services
Management
Companies
Enterprises
Solutions
Claims
Analytics and
Others
Reporting
▪
In this section you will get an understanding of the segmentations which will cover the Canada Healthcare Claims Management
Market
▪
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 27
2.2.1 Market Segmentation: By Service Type
Canada Healthcare Claims Management Market Share, By
Services Type (2022)
▪
Claims Processing market in Canada is
a significant component of the overall
Healthcare Claims Management market
▪
It has the maximum market share in
Canada market with approximately
Claims Analytics
and Reporting
xx%
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
Claims
analysis that will be presented in the
Processing
final report
Claims Denial
Management
▪
In order to obtain access to all of the
information that you are seeking, you
will need to purchase the final report
▪
Final report will be comprehensive and
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 28
2.2.2 Market Segmentation: By Deployment Mode
Canada Healthcare Claims Management Market Share, By
Deployment Mode (2022)
▪
On-Premises market in Canada is a
significant component of the overall
cancer market
▪
It has the maximum market share in
Canada market with approximately
xx%
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
Cloud-Based
analysis that will be presented in the
On-Premises
final report
▪
In order to obtain access to all of the
information that you are seeking, you
will need to purchase the final report
▪
Final report will be comprehensive and
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 29
2.2.3 Market Segmentation: By End User
Canada Healthcare Claims Management Market Share, By End User (2022)
▪
Hospitals have the maximum market
share in Canada market with
approximately xx%
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
Other
analysis that will be presented in the
Healthcare
final report
Providers
▪
In order to obtain access to all of the
Hospitals and
information that you are seeking, you
Clinics
will need to purchase the final report
Insurance
Companies
▪
Final report will be comprehensive and
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 30
2.2.3 Market Segmentation: By Component
Canada Healthcare Claims Management Market Share, By
Component (2022)
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the
final report
▪
In order to obtain access to all of the
information that you are seeking, you
will need to purchase the final report
Services
▪
Final report will be comprehensive and
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
Software
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 31
2.2.3 Market Segmentation: By Organization Size
Canada Healthcare Claims Management Market Share, By
Organization Size (2022)
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the
final report
▪
In order to obtain access to all of the
information that you are seeking, you
will need to purchase the final report
Large
▪
Enterprises
Final report will be comprehensive and
detailed, and it will include data,
SMEs
analysis, trends, and other relevant
information related to the topic or
subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 32
2.2.3 Market Segmentation: By Mode of Delivery
Canada Healthcare Claims Management Market Share, By Mode of Delivery (2022)
▪
Please be aware that this sample report
is intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the
final report
▪
In order to obtain access to all of the
information that you are seeking, you
Standalone
will need to purchase the final report
Solutions
▪
Final report will be comprehensive and
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
Integrated
Solutions
subject matter of interest
Integrated Solutions
Standalone Solutions
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 33
Canada Healthcare Claims Management Market Analysis
3. Market Dynamics
3.1 Market growth drivers
3.1.1 In 2022, total health spending in Canada is projected to reach $331 Bn, equivalent to $8,563 per Canadian, representing approximately 12.2% of the country's gross domestic product (GDP)
▪
Rising healthcare expenditure in Canada is driving the need for efficient National health expenditure trends
claims management
▪
As healthcare costs continue to increase, healthcare providers and payers are seeking ways to streamline claims processing, reduce administrative costs, and optimize reimbursement to manage overall healthcare expenditures effectively
▪
Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will be presented in the final report
▪
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
▪
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or subject matter of interest
2010
2022
2030
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 35
3.1 Market growth drivers (continued)
3.1.2 Growing Emphasis on Data Analytics
▪
There is a growing emphasis on data analytics in healthcare Top countries that are leveraging
claims management
technology in their fight against cancer
▪
Advanced analytics tools enable the identification of trends, Norway
patterns, and anomalies in claims data, allowing healthcare Austria
Denmark
organizations to detect fraud, improve coding accuracy, and Belgium
optimize revenue cycle management
Spain
Italy
▪
Integration of data analytics in claims management
Netherlands
processes is driving efficiency and cost savings
Sweden
Singapore
▪
In order to obtain access to all of the information that you are Switzerland
seeking, you will need to purchase the final report
Israel
Australia
▪
Final report will be comprehensive and detailed, and it will Canada
include data, analysis, trends, and other relevant information France
related to the topic or subject matter of interest
United Kingdom
China
South Korea
Germany
Japan
United States
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 36
3.1 Market growth drivers (continued)
3.1.3 Technological Advancements
▪
Technological advancements in healthcare IT, such as
automation, artificial intelligence (AI), and machine learning, are transforming healthcare claims management
▪
Automation can streamline claims processing, reduce
manual errors, and accelerate reimbursement cycles
▪
AI-powered systems can help identify fraudulent claims,
improve coding accuracy, and enhance overall claims
XX
management efficiency
XX
▪
Please be aware that this sample report is intended to
provide you with a brief overview of the kind of information and analysis that will be presented in the final report
▪
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
2022
2023F
2024F
2025F
2026F
2027F
2028F
2029F
2030F
▪
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 37
3.2 Market restraints
3.2.1 Complex Regulatory
3.2.2 Fragmented Data
3.2.3 Limited Integration with
Environment
Systems
Electronic Health Records (EHRs)
▪
Complex regulatory environment
▪
Fragmentation of data systems
▪
Integration of claims
in healthcare, including
and lack of interoperability
management systems with
compliance with privacy laws,
between healthcare
electronic health records (EHRs)
billing regulations, and
organizations and payers can
can enhance the accuracy and
reimbursement policies, poses a
hinder efficient claims
efficiency of claims processing
challenge for claims
management
▪
However, the limited integration
management
▪
Inconsistent data formats, limited
between claims management
▪
Adhering to various regulations
data sharing, and siloed
systems and EHRs can pose
across different provinces and
information can result in delays,
challenges, leading to manual
territories can create complexity
errors, and challenges in claims
data entry, data discrepancies,
and increase administrative
processing and coordination
and potential errors in claims
burdens, impacting the efficiency
among stakeholders
submission and processing.
and speed of claims processing
Our analysis will thoroughly investigate the key restraints that may significantly impact business
operations and growth.
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 38
Canada Healthcare Claims Management Market Analysis
4. Competitive Landscape
4.1 Major Market Share
Revenue of Major Players in Canada Healthcare Claims
▪
Canada Healthcare Claims Management
Management Market ($ Mn)
Market is a highly competitive space, with
many companies developing and marketing
Other
cancer treatments
▪
Some of the top companies in Canada
cancer market based on revenue and
market share include
XX
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 40
4.2 Key Company Profile
Key Note:
1
Accenture
▪
Here is the list of top 10 companies which
will cover in the final report
2
IBM Corporation
▪
Each company will have slides for
o Overview
3
McKesson Corporation
o Key details
4
Infosys Limited
o Offerings
o Name of products
5
Cognizant
o Recent activities/ Press Coverage
o Distribution and Vendor Partners
6
TELUS Health
o Mergers, Acquisitions and
Collaboration
7
Optum, Inc.
o Financials
8
CGI Group Inc.
▪
If there are specific companies that you
would like to be included in the report,
please let us know via email
9
Change Healthcare
▪
In order to obtain access to all of the
information that you are seeking, you will
Allscripts Healthcare
10
need to purchase the final report
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 41
4.2.1 Accenture
Offerings in Hea
▪ Accenture is a global professional services company that provides Founded in: 1989
➢ Consulting Services
a wide range of services, including consulting, technology, and outsourcing solutions
HQ: Dublin, Ireland
➢ Technology Solutions
▪ It offers expertise in healthcare and has experience in supporting
➢ Analytics and Data Insights
healthcare claims management processes
Type: Private
▪ In the context of healthcare claims management, Accenture
➢ Automation and Digital
Total Revenue: $61.6 Bn
provides consulting services, technology solutions, and process Transformation
optimization strategies to help healthcare organizations streamline Website: www.accenture.com
➢ Claims Audit and Compliance
their claims operations and improve efficiency
➢ Fraud Detection and Prevention
Recent Activity / Press Coverage
Accenture has announced its intent to acquire Green Domus Desenvolvimento Sustentável LTDA, a leading Brazil-based sustainability consultancy with experience helping clients design and implement a range of sustainability services with a focus on measurable decarbonization strategies Celent report titled, “New Business and Underwriting Systems: North America Individual Life Insurance Edition,” recognizes the Accenture Life Insurance & Annuity Platform (ALIP) as one of the highest-rated solutions among nine new business and underwriting systems in the Advanced Technology category, awarded every two years
Accenture, Microsoft and Unilever have completed one of the largest and most complex cloud migrations in the consumer goods industry A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 42
4.2.1 Accenture (continued)
Partnerships Ecosystem
Major Distribution Partners
Major Vendor Partners
One of the largest pharmaceutical
Roche has been working with SAP, a
distributors in the United States, McKesson
leading software company, to develop digital
has been a long-standing distribution
solutions for its healthcare products
partner for Roche
Cardinal Health is a Fortune 500 healthcare
A leading Swiss biotechnology company,
services company that provides
Lonza provides Roche with contract
pharmaceutical distribution services to
manufacturing services for the production of
Roche
its biologics and pharmaceuticals
It is one of the largest drugstore chains in
Roche has a strategic partnership with
the United States and Europe, and its
Microsoft to leverage its cloud computing
extensive network of retail locations and
and AI technologies in the development of
distribution centers make it an important
new healthcare products
distribution partner for Roche
Thermo Fisher Scientific is a leading
A leading healthcare services provider in
provider of analytical instruments, reagents,
Asia, Zuellig Pharma is a distribution
and laboratory services
partner for Roche in several Asian countries
One of the largest pharmaceutical
GE Healthcare provides Roche with
wholesalers in Europe, PHOENIX Group
advanced medical imaging and diagnostics
distributes Roche's products in several
technologies, including CT scanners and
European countries
MRI machines
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 43
4.2.1 Accenture (continued)
Latest Deals - Mergers and Acquisitions
Amount /
Company Name
Type
Year
Key Pointers
Duration
▪
Accenture has completed its acquisition of Objectivity, a digital engineering firm specializing in cloud and platform development services that help clients accelerate their transformation journey for rapid innovation
Acquisition
-
May, 2023
▪
Objectivity’s extensive experience in platform engineering, cloud Objectivity
native computing and application modernization bolsters
Accenture’s Cloud First capabilities to help clients tap into more open and adaptable platform models and services in order to accelerate their digital transformation
▪
Accenture has completed its acquisition of Einr AS, a business consulting company specialized in high volume logistics solutions using SAP® technologies to optimize the flow of products from Acquisition
-
manufacturers to consumers, headquartered in Oslo, Norway May, 2023
Einr AS
▪
Acquisition further enhances Accenture’s SAP capabilities, helping it to accelerate supply chain reinvention for organizations within the retail and consumer electronics industries
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 44
4.2.1 Accenture (continued)
Revenues ($Bn), 2020-2030
▪
According to Accenture's 2022 financial
report, the company had a record increase
of 22% in revenue
▪
Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
report
2020
2021
2022
2023F
2024F
2025F
2026F
2027F
2028F
2029F
2030F
▪
In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
Breakdown of Net Revenue by Segment, 2022
revenue and other key details as per
availability
▪
In order to obtain access to all of the
information that you are seeking, you will
need to purchase the final report
1
2
3
4
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 45
4.2.2 Company 2
Solutions offered by Company
Founded in:
HQ:
Type:
Revenue:
Website:
Drugs for Cancer
Recent Activity / Press Coverage
Drugs
Indications
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 46
4.2.2 Company 2 (continued)
Partnerships Ecosystem
Major Distribution Partners
Major Vendor Partners
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 47
4.2.2 Company 2 (continued)
Latest Deals - Mergers and Acquisitions
Amount /
Company Name
Type
Year
Key Pointers
Duration
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 48
4.2.2 Company 2 (continued)
Revenues ($Bn), 2020-2030
▪
Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
xx
xx
xx
report
▪
In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
revenue and other key details as per
2020
2021
2022
2023F
2024F
2025F
2026F
2027F
2028F
2029F
2030F
availability
▪
In order to obtain access to all of the
Breakdown of Net Revenue by Segment, 2022
information that you are seeking, you will
need to purchase the final report
▪
Final report will be comprehensive and
detailed, and it will include data, analysis,
trends, and other relevant information
related to the topic or subject matter of
interest
1
2
3
4
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 49
Canada Healthcare Claims Management Market Analysis
5. Reimbursement Scenario
5.1 Reimbursement Regulation
Public Insurance provides health
The reimbursement scenario in the Canada Healthcare Claims Management insurance coverage for more than 8 in 10
Market is complex and can vary depending on the specific treatment, setting of care, and insurance coverage. Here are some key points to consider: People
▪
Public Insurance:
o Medicare is a federal health insurance program for people aged 65 and Other Public
older, as well as people with certain disabilities or health conditions 1%
o Medicare covers many cancer treatments, including chemotherapy, Other Private
radiation therapy, and some immunotherapies
3%
Uninsured
o
9%
However, coverage can be subject to strict guidelines and restrictions, 17%
such as the requirement for prior authorization
o Medicaid is a joint federal-state program that provides health insurance for people with low incomes
o Medicaid coverage for cancer treatments can vary by state and may be subject to limits on the amount and type of treatment covered
▪
Private Insurance:
21%
o Private insurance coverage for cancer treatments can also vary widely depending on the insurer and the specific policy
o Some policies may have high out-of-pocket costs, such as deductibles Employer-Sponsored
49%
and co-pays, while others may have more comprehensive coverage Health Insurance Coverage, 2022
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 51
5.1 Reimbursement Regulation (continued)
▪
Affordable Care Act:
o Affordable Care Act (ACA) includes provisions to help improve access to cancer treatments by requiring insurers to cover certain preventive services, including cancer screenings, without co-pays or deductibles o It also includes protections for people with pre-existing conditions, such as cancer
▪
Reimbursement for New Treatments:
o Reimbursement for new cancer treatments can be a complex and lengthy process, as insurers and government programs often require evidence of safety and effectiveness before providing coverage o This can create challenges for companies developing and marketing new treatments
▪
Value-Based Care:
o There is a growing trend towards value-based care, which aims to improve outcomes and lower costs by focusing on the value of treatments rather than simply the volume of treatments o Value-based care models can include payment models that tie reimbursement to outcomes or performance metrics In order to obtain access to all of the information that you are seeking, you will need to purchase the final report Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 52
5.1 Reimbursement Regulation (continued)
Coverage Penetration (% Total Population)
Source of Funding
Spend on Healthcare (%of Current Health Expenditure)
100%
100%
100%
100%
100%
0%
Government Expenditure
0%
xx
xx
xx
xx
xx
7%
Public Healthcare
44.
0%
8%
46.
47.
51.
51.
Private Health Insurance
Coverage
Out of Pocket
Private Coverage
9%
1%
6%
5%
5%
38.
37.
35.
32.
31.
Other
NA
NA
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Public healthcare coverage is provided by the government and includes programs like Medicare and Medicaid
6.3%
4.08%
5.1%
3.8%
2.2%
2.4%
3.6%
GDP Growth (yoy)
Medicare is a federal program that provides healthcare coverage to individuals who are 65 years of age or older, as well as certain younger people with disabilities 14.7%
11.3%
15.5%
7.5%
4.2%
NA
NA
HC Spend Growth (yoy)
Medicaid is a joint federal-state program that provides healthcare coverage to individuals with low income and limited resources
Reimbursement Market Trends
▪ Shift towards value-based care has been a significant trend in the US healthcare system, with payers and providers increasingly focused on improving patient outcomes and reducing costs
▪ This has led to the development of alternative payment models such as accountable care organizations (ACOs) and bundled payment arrangements, which incentivize providers to deliver high-quality, cost-effective care Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 53
5.2 Reimbursement Process for Diagnosis
The reimbursement process in the US healthcare system can be complex and can vary depending on the type of healthcare service, the healthcare provider, and the insurance coverage. Here are the general steps involved in the reimbursement process:
▪
Service or Treatment Provided: The healthcare provider performs a service or treatment for the patient
▪
Billing: The healthcare provider submits a claim to the insurance company or other payer, requesting reimbursement for the service provided
▪
Adjudication: The insurance company or other payer reviews the claim to determine whether it meets the criteria for reimbursement. This can involve verifying the patient's eligibility, reviewing the treatment provided, and checking for any potential errors or fraud
▪
Payment: If the claim is approved, the insurance company or other payer reimburses the healthcare provider for the service provided, based on the negotiated payment rates or fee schedule
▪
Patient Responsibility: Depending on the patient's insurance coverage, they may be responsible for paying a portion of the cost of the service, such as deductibles, co-payments, or co-insurance In order to obtain access to all of the information that you are seeking, you will need to purchase the final report Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or subject matter of interest
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 54
5.3 Reimbursement Process for Treatment
The reimbursement process in the US healthcare system can be complex and can vary depending on the type of healthcare service, the healthcare FDA
provider, and the insurance coverage. Here are the general steps involved in the reimbursement process:
▪
Service or Treatment Provided: The healthcare provider performs a Market Authorization
service or treatment for the patient
▪
Billing: The healthcare provider submits a claim to the insurance company or other payer, requesting reimbursement for the service Private Payers
Public Payers
provided
▪
Adjudication: The insurance company or other payer reviews the claim to determine whether it meets the criteria for reimbursement. This can involve verifying the patient's eligibility, reviewing the treatment Health Technology Assessment
provided, and checking for any potential errors or fraud
▪
Payment: If the claim is approved, the insurance company or other 1
2
3
payer reimburses the healthcare provider for the service provided, Coding
Coverage
Payment
based on the negotiated payment rates or fee schedule
Coding depends on availability code while coverage and
payment process decisions are made through an HTA.
Illustrative
A Sample Report on Canada Healthcare Claims Management Market Analysis I Confidential 55
Canada Healthcare Claims Management Market Analysis
6. Methodology & Scope
▪
Insights 10’s research methodology delves deeper into the market, covering the macro and micro aspects of the industry. We identify the key growth drivers, opportunities, and restraints that might promote or hinder the future industry growth along with an expansive overview of the competitive landscape to help our clients make informed strategic decisions
▪
We implement a mix of primary and secondary research for our market estimate and forecast. The secondary research forms the initial phase of our study where we conduct extensive data mining, referring to verified data sources such as independent studies, government and regulatory published material, technical journals, trade magazines, and paid data sources
▪
For forecasting, the following parameters are considered:
❑
Market drivers and restraints along with their current and expected impacts
❑
Technological scenario and expected developments
❑
End use industry trends and dynamics
❑
Trends in the consumer behavior
❑
Regulatory scenario and expected developments
❑
Current capacity and expected capacity additions up to 2030
▪
We assign weights to these parameters and quantify their market impacts using the weighted average analysis to derive the expected market growth rate
▪
We appoint data triangulation strategies to explore different areas of the market. Our qualitative and quantitative assessments are time-sensitive, reflecting the most recent value and volume of the market across regions
▪
All our estimates and forecasts are verified through exhaustive primary research with the Key Industry Participants (KIPs)
▪
Currency used in the report is the US dollar (USD), with the market size indicated in USD million/billion (Mn/Bn)
Analysis Methodology
Our Analysis Methodology involves three critical stages: Data
Market Data Analysis
Interpretation &
Collection
& Statistical Model
Presentation
Secondary
Analysis &
Market Trends
Research
Interpretation
Primary
Market Sizing &
Insights
Research
Analysis
Proprietary
Data Triangulation &
Presentation &
Database
Validation
Reporting
Data Triangulation & Data Validation
Top Down Approach
Final
Final Market size break up to
Market
rest of segmentation
Size
Validation from
Arriving at market size
Primary Interview
of each segment
Summarization of revenue
generated from companies
Validation from
to arrive at total market size
Primary Interview
Revenue generated by products &
Final
services offered by companies
Summary
Bottom Up Approach
Key Benefits for Stakeholders from this Report Study provides an in-depth analysis of the market with current trends and future estimations to elucidate the imminent investment pockets
Our tools provides stakeholders with a cohesive understanding of the industry outlook, considering the qualitative and quantitative industry variables
Comprehensive analysis of factors that drive and restrict the market growth is provided Comprehensive quantitative analysis of the industry from 2022 to 2030F is provided to enable the stakeholders to capitalize on the prevailing market opportunities
Extensive analysis of the key segments of the industry helps understand the applications and technologies used globally Our rigorous data collection, thorough statistical analysis and specialist assessments ensure that our clientele has a greater understanding of the industry space, supply chain, price fluctuations, competitive landscape, and other vital factors
Time Frame
Report Attribute
Details
Quantitative Units
Revenue in USD Million/Billion (Mn/Bn)
Base Year for
2022
Estimation
Market Overview, Revenue Forecast, Market
Segmentation, Growth Factors and Trends,
Report Coverage
Company Profiles, Competitive Landscape,
Regulatory Landscape, Future Opportunities
Report Customization (3 to 5 working days)
with purchase. We will provide you with data
Customized Report
that is currently not a part of our scope as a
2023-
Forecast
