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市場調查報告書
商品編碼
1842422

收益週期管理：市場佔有率分析、產業趨勢與統計、收益預測（2025-2030）

Revenue Cycle Management - Market Share Analysis, Industry Trends & Statistics, Growth Forecasts (2025 - 2030)
出版日期: | 出版商: Mordor Intelligence | 英文 130 Pages | 商品交期: 2-3個工作天內

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簡介目錄

預計到 2025 年收益週期管理市場價值將達到 864.5 億美元，到 2030 年將達到 1,412 億美元，複合年成長率為 10.31%。

收入週期管理-市場-IMG1

不斷成長的管理費用、向基於價值的報銷的轉變以及人工智慧的日益普及，這些因素共同推動了自動化收益獲取成為董事會層面的當務之急。醫療保健組織正在優先考慮將臨床文件、不可否認性和現金流分析整合到單一工作區中的整合平台，以減少手動工作並縮短應收帳款處理時間。雖然北美醫療保健系統繼續支持需求，但亞太地區的私人保險滲透率正在擴大新的可尋址量。雖然由於持續的人手不足，服務外包仍然盛行，但雲端軟體的快速發展標誌著從密集型模式逐漸轉向可隨患者數量擴展的基於訂閱的架構。這導致能夠將預測分析和合規性更新組合成單一可互通堆疊的技術供應商之間的競爭加劇。

全球收益周期管理市場趨勢與洞察

全球轉向基於價值和基於績效的報銷

基於價值的醫療服務如今已融入與主要付款方簽訂的合約中，並透過將付款與臨床品質而非服務量掛鉤，重塑了收益週期管理行業的優先事項。採用負責任醫療框架的醫療系統已累積節省超過7億美元，證明了當組織掌握品質指標時，其財務效益是存在的。為此，RCM平台正在整合人口健康儀錶板，將臨床結果轉化為報銷觸發機制，使醫療服務提供者能夠在醫療服務缺口成為支付風險之前對其進行追蹤。這種演變隱含地要求來自不同來源的標準化數據，這使得互通性具有新的商業性緊迫性。

日益增加的行政成本壓力推動 RCM 自動化

由於行政管理成本占美國醫療支出的20-25%，高階主管認為自動化是遏止成本上升的有效途徑。人工智慧機器人可以在幾秒鐘內完成常規預核准交易，而這些交易以前需要人工審核，工作人員還需要數天的後續交易。一些醫院自實施以來，結算時間縮短了50%。這些改進使結算負責人能夠專注於複雜的異常處理，而計劃外的生產力提升則使經營團隊能夠專注於面向患者的任務。重要的是，已實現入院到結算工作流程自動化的醫療保健機構報告稱，由於省去了繁瑣且容易出錯的資料輸入工作，員工滿意度有所提高。

異質且不斷變化的付款人規則和編碼標準

拒付率仍維持在10-15%左右，證明了付款人更新編輯和政策的速度之快。醫療保健集團的領導者預計，2024年的拒付率將進一步上升，這促使各機構投資於持續的程式碼更新和預測性清理器，以便在提交之前標記潛在的拒付情況。領先的醫療系統擁有專門的團隊來調查拒付的根本原因，而編碼員和臨床醫生之間的迭代回饋循環縮短了補救週期。人工智慧主導的規則引擎能夠從付款人匯款中自我學習，目前正在大幅減少附件請求數量並降低管理開銷。

報告中分析的其他促進因素和限制因素

  1. 數位健康加速發展，互通性成為全球要求
  2. 醫療保健消費化，病患帳單日益複雜
  3. 熟練編碼和 RCM 人才持續短缺

細分分析

到2024年，服務將佔收益週期管理市場規模的78%，這反映出在人才短缺的情況下，供應商更傾向於提供承包的專業服務。客戶將外包視為快速獲得更高回報的途徑，因為服務合作夥伴將承擔技術投資和持續流程改善的責任。即便如此，由於訂閱定價將成本與使用量掛鉤，並消除了大規模資本投資的障礙，雲端基礎的軟體將超過整體市場成長率，到2030年複合年成長率將達到14.2%。

採用雲端收入週期管理 (RCM) 套件的醫院通常會發現更多好處，例如即時儀表板可查看醫生文件的缺失，從而能夠在單一班次內提供糾正指導。隨著時間的推移，這些分析功能會鼓勵內部團隊從交易營運轉型為策略性收入完整性角色。這兩種成長模式表明，將內部監督與選擇性外包相結合的混合營運模式將變得更加普遍，從而為軟體公司和服務機構在收益週期管理行業拓展更多機會。

到2024年，本地收益周期管理將佔據58.5%的市場。然而，由於靈活的基礎設施、自動升級以及與付款人API的輕鬆整合，到2030年，雲端採用率將以14.2%的複合年成長率成長。在HFMA技術採用曲線上不斷上升的組織經常將雲端遷移視為週期時間指標開始下降的曲折點。雲端供應商可以更快地實施監管程式碼集，因為他們可以集中推送更新，而無需依賴客戶IT團隊。

隨著網路安全框架的日趨成熟，異地正在逐漸消退，財務長們也注意到，可預測的訂閱費用簡化了多年的預算編制。這種成本透明度是加速整體收益週期管理市場成長的隱形驅動力，因為曾經只有大型學術中心才能使用的功能，現在也可供中型醫院使用。

區域分析

北美佔據了當前收益週期管理市場的48%，這得益於其複雜的多付款人框架和悠久的EHR實施歷史。供應商整合非常活躍，89億美元的R1 RCM交易顯示私募股權相信規模化的流程專業知識將顯著改善現金流。 46%的美國醫院報告稱已在其收益週期工作流程中使用某種形式的人工智慧。有趣的是，加拿大的單一付款人系統仍然需要RCM工具進行省際對賬，這表明付款人的複雜性並非成長的唯一驅動力。該地區的報銷透明度創造了豐富的資料集，使供應商能夠比其他地區更快地完善機器學習模型，從而鞏固了北美的領導地位。

預計到 2030 年，亞太地區的複合年成長率將達到 16.4%，成為收益週期管理行業中成長最快的地區，這得益於政府支持的數位醫療投資和中階對私人保險日益成長的需求。在印度，國家健康保險的擴大正在使計費基礎設施標準化，而儘早實現計費數位化的醫院可以縮短結算時間。中國三線城市的醫院擴大尋求基於雲端的收入週期管理 (RCM)，以超越傳統的客戶端-伺服器模式，這與其他行業的智慧型手機普及曲線如出一轍。在日本等市場，資料本地化法律決定了託管架構，因此，本地合作夥伴對於獲得監管部門的核准至關重要。這種調適需求為全球供應商設置了進入壁壘，但也為那些搶先的企業帶來了豐厚回報。

在歐洲，收益週期管理市場佔有率仍然很高，儘管由於許多國家採用集中計費標準的單一付款人模式，成長已經穩定下來。然而，GDPR的要求正在推動醫院走向具有嚴格加密和審核追蹤的雲端環境，促使擁有豐富隱私工程經驗的美國和歐洲軟體公司之間建立合資企業。在英國，國家醫療服務體系（NHS）重新將重點放在減少積壓案件上，這導致人們對類似於私人RCM的人工智慧調度和理賠分類功能的興趣日益濃厚。同時，私人醫院連鎖正在推動中東/非洲和南美的早期需求，這些新興地區一旦法律規範成熟，就具備加速採用的基礎。

其他福利：

  • Excel 格式的市場預測 (ME) 表
  • 3個月的分析師支持

目錄

第1章 引言

  • 研究假設和市場定義
  • 調查範圍

第2章調查方法

第3章執行摘要

第4章 市場狀況

  • 市場概況
  • 市場促進因素
    • 全球醫療收費轉向基於價值和與結果掛鉤
    • 管理成本壓力不斷增加推動 RCM 自動化
    • 數位醫療加速發展，全球要求互通性
    • 醫療保健消費化增加了病患帳單的複雜性
    • 雲端原生醫療 IT 平台和 SaaS 經濟的興起
  • 市場限制
    • 多樣化且不斷變化的付款人法規和編碼標準
    • 熟練編碼和 RCM 人才持續短缺
    • 受保護的健康資訊的資料隱私和網路安全風險
    • 前期投資高，變更管理障礙多
  • 技術展望
  • 五力分析
    • 新進入者的威脅
    • 買方的議價能力
    • 供應商的議價能力
    • 替代品的威脅
    • 競爭的激烈程度

第5章市場規模與成長預測（價值，美元）

  • 按組件
    • 軟體
      • 整合 RCM 套件
      • 獨立模組
    • 服務
      • RCM外包BPO
      • 諮詢與培訓
  • 按部署
    • 雲端基礎
    • 本地部署
  • 按功能
    • 理賠與拒賠管理
    • 醫療編碼和計費
    • 電子健康記錄（整合RCM）
    • 臨床文件改進（CDI）
    • 保險資格驗證
    • 其他功能（患者安排、價格透明度）
  • 按最終用戶
    • 醫院
    • 醫院和診所
    • 門診手術中心
    • 檢驗中心
    • 診斷影像中心
    • 其他最終用戶
  • 按專業
    • 放射學
    • 腫瘤學
    • 循環系統
    • 病理
    • 其他
  • 地區
    • 北美洲
      • 美國
      • 加拿大
      • 墨西哥
    • 歐洲
      • 德國
      • 英國
      • 法國
      • 義大利
      • 西班牙
      • 其他歐洲國家
    • 亞太地區
      • 中國
      • 日本
      • 印度
      • 澳洲
      • 韓國
      • 其他亞太地區
    • 中東和非洲
      • GCC
      • 南非
      • 其他中東和非洲地區
    • 南美洲
      • 巴西
      • 阿根廷
      • 其他南美

第6章 競爭態勢

  • 市場集中度
  • 市佔率分析
  • 公司簡介
    • Optum（UnitedHealth Group）
    • R1 RCM Inc.
    • Conifer Health Solutions
    • Cognizant（Trizetto）
    • athenahealth
    • Oracle Cerner
    • Epic Systems
    • Veradigm LLC
    • Solventum
    • GeBBS Healthcare
    • MCKESSON Corporation
    • Accenture Health
    • Infosys Limited
    • Med-Metrix
    • Access Healthcare
    • Conduent
    • eClinicalWorks
    • XIFIN
    • Quest Diagnostics RCM
    • HCLTech Healthcare

第7章 市場機會與未來展望

簡介目錄
Product Code: 62795

The revenue cycle management market is valued at USD 86.45 billion in 2025, is set to expand at a 10.31% CAGR, and should reach USD 141.20 billion by 2030.

Revenue Cycle Management - Market - IMG1

Expanding administrative overhead, the pivot toward value-based reimbursement, and widening AI adoption are combining to make automated revenue capture a board-level necessity. Providers are prioritizing integrated platforms that merge clinical documentation, denial avoidance, and cash-flow analytics in one workspace, cutting manual touches and shortening days in accounts receivable. North American health systems continue to anchor demand, yet rising private-insurance penetration in Asia-Pacific is unlocking sizable new addressable volumes. Service outsourcing remains prevalent because staffing gaps persist, but cloud software's rapid acceleration signals a gradual hand-off from labor-heavy models to subscription-based architectures that scale with patient volumes. The net effect is heightened competition among technology vendors that can wrap predictive analytics and compliance updates into a single, interoperable stack.

Global Revenue Cycle Management Market Trends and Insights

Global Shift Toward Value-Based & Outcome-Linked Reimbursement

Value-based care, now written into major payer contracts, is recasting Revenue Cycle Management industry priorities by tying payment to clinical quality rather than service volume. Health systems that adopted accountable care frameworks recorded collective savings in excess of USD 700 million, proving that financial upside exists once organizations master quality metrics. As a response, RCM platforms are integrating population-health dashboards that translate clinical outcomes into reimbursement triggers, ensuring that providers track gaps in care before payment risk materializes. That evolution implicitly demands normalized data from disparate sources, giving interoperability a new commercial urgency.

Escalating Administrative Cost Pressure Prompting RCM Automation

Administrative expenses routinely consume 20 - 25 % of United States healthcare spending, so executives view automation as a proven lever to arrest cost inflation. AI-enabled bots now complete routine prior authorization transactions in seconds, a process that previously required manual review and days of staff follow-up, and some hospitals have documented a 50 % reduction in claim preparation time after deployment. These improvements free billing professionals to concentrate on complex exceptions, generating an unplanned productivity dividend that management can redeploy toward patient-facing roles. Importantly, institutions that automate admit-through-cash workflows report heightened staff satisfaction because tedious, error-prone data entry tasks disappear.

Heterogeneous, Ever-Changing Payer Rules and Coding Standards

Denial rates hovering around 10 - 15 % illustrate how quickly payer edits and policy updates can overturn otherwise compliant claims. Medical group leaders confirm that denials climbed further in 2024, so organizations are investing in continuous code updates and predictive scrubbers that flag likely rejections before submission. Forward-looking health systems allocate dedicated teams to mine denial root causes, and iterative feedback loops between coders and clinicians are shortening correction cycles. AI-driven rules engines that self-learn from payer remittances now deliver measurable reductions in attachment requests, cutting administrative overhead.

Other drivers and restraints analyzed in the detailed report include:

  1. Accelerated Digital-Health & Interoperability Mandates Worldwide
  2. Consumerization of Healthcare Increasing Patient Billing Complexity
  3. Persistent Shortage of Skilled Coding and RCM Talent

For complete list of drivers and restraints, kindly check the Table Of Contents.

Segment Analysis

Services hold 78% market share of the Revenue Cycle Management market size in 2024, mirroring providers' preference for turnkey expertise amid staffing shortages. Clients view outsourcing as an immediate route to improved collections because service partners assume responsibility for technology investment and continuous process refinement. Nevertheless, cloud-based software is posting a 14.2% CAGR through 2030, more than the overall market growth, because subscription pricing aligns cost with usage and removes large capital hurdles.

Hospitals that implement cloud RCM suites often discover secondary benefits, such as real-time dashboards that spotlight physician documentation gaps, enabling corrective coaching within a single shift. Over time, these analytics capabilities encourage in-house teams to transition from transactional tasks to strategic revenue integrity roles. The dual-track growth pattern implies that hybrid operating models, combining retained oversight with selective outsourcing-will become common, broadening the Revenue Cycle Management industry opportunity for both software firms and service bureaus.

On-premise deployments retain 58.5% Revenue Cycle Management market share in 2024, reflecting earlier capital purchases and residual security concerns. Yet cloud installations are expanding at a 14.2% CAGR to 2030, propelled by flexible infrastructure, automatic upgrades, and easier integration with payer APIs. Organizations that climb the HFMA technology-adoption curve frequently cite cloud moves as the inflection point when cycle-time metrics start to trend downward. One observed benefit is faster implementation of regulatory code sets, since cloud vendors push updates centrally instead of relying on client IT teams.

As cyber-security frameworks mature, board-level resistance to off-site hosting is receding, and CFOs note that predictable subscription fees simplify multi-year budgeting. This cost transparency acts as a hidden accelerant to overall Revenue Cycle Management market size growth because even mid-tier hospitals can now access features that were once reserved for large academic centers.

The Revenue Cycle Management Market is Segments by Component (Software [Integrated RCM Suite, and More], and Services [Outsourced RCM BPO, and More]), Deployment (Cloud-Based and On-Premise), Function (Claims & Denial Management, and More) End User (Hospitals, Laboratories, and More), Specialty (Radiology, Oncology, and More) and Geography (North America, Europe, and More). The Market Forecasts are Provided in Terms of Value (USD).

Geography Analysis

North America commands 48% of the current Revenue Cycle Management market size, supported by complex multi-payer frameworks and a long history of EHR adoption. Vendor consolidation is active, evidenced by R1 RCM's USD 8.9 billion transaction, signaling private-equity conviction that scaled process expertise can deliver outsized cash-flow gains. Hospitals in the United States report that 46% already utilize some form of AI in revenue-cycle workflows. Interestingly, Canadian single-payer structures still require RCM tools for provincial reconciliation, revealing that payer complexity is not the only growth driver. The region's reimbursement transparency mandates create rich data sets, enabling vendors to refine machine-learning models faster than elsewhere, reinforcing North American leadership.

Asia-Pacific is forecast to post a 16.4% CAGR through 2030, the fastest regional pace in the Revenue Cycle Management industry, propelled by government-backed digital-health investments and swelling middle-class demand for private insurance. India's national insurance expansion is catalyzing standardized claims infrastructure, and hospitals that digitize billing early capture accelerated settlement times. China's tier-three city hospitals increasingly seek cloud RCM to leapfrog older client-server models, mirroring the smartphone adoption curve seen in other industries. Local partners remain critical for navigating regulatory approval in markets such as Japan, where data localization laws shape hosting architecture. This need for contextual adaptation presents a barrier to entry for global vendors but simultaneously offers high returns to firms that secure first-mover standing.

Europe retains meaningful Revenue Cycle Management market share, although growth is steadier because many countries operate single-payer models that centralize claim standards. Even so, GDPR requirements push hospitals toward cloud environments with strict encryption and audit trails, spurring joint ventures between U.S. and European software firms experienced in privacy engineering. In the United Kingdom, the National Health Service's renewed focus on backlog reduction has elevated interest in AI scheduling and billing triage features that resemble private-sector RCM. Meanwhile, Middle East, Africa, and South America represent emerging territories where private hospital chains drive early demand, setting a foundation for accelerated adoption once regulatory frameworks mature.

  1. Optum (UnitedHealth Group)
  2. R1 RCM
  3. Conifer Health Solutions
  4. Cognizant (Trizetto)
  5. athenahealth
  6. Oracle
  7. Epic Systems
  8. Veradigm
  9. Solventum
  10. GeBBS Healthcare
  11. MCKESSON Corporation
  12. Accenture Health
  13. Infosys
  14. Med-Metrix
  15. Access Healthcare
  16. Conduent
  17. eClinicalWorks
  18. XIFIN
  19. Quest Diagnostics RCM
  20. HCLTech Healthcare

Additional Benefits:

  • The market estimate (ME) sheet in Excel format
  • 3 months of analyst support

TABLE OF CONTENTS

1 Introduction

  • 1.1 Study Assumptions & Market Definition
  • 1.2 Scope of the Study

2 Research Methodology

3 Executive Summary

4 Market Landscape

  • 4.1 Market Overview
  • 4.2 Market Drivers
    • 4.2.1 Global Shift Toward Value-Based & Outcome-Linked Reimbursement
    • 4.2.2 Escalating Administrative Cost Pressure Prompting RCM Automation
    • 4.2.3 Accelerated Digital-Health & Interoperability Mandates Worldwide
    • 4.2.4 Consumerization of Healthcare Increasing Patient Billing Complexity
    • 4.2.5 Proliferation of Cloud-Native Health IT Platforms & SaaS Economics
  • 4.3 Market Restraints
    • 4.3.1 Heterogeneous, Ever-Changing Payer Rules and Coding Standards
    • 4.3.2 Persistent Shortage of Skilled Coding & RCM Talent
    • 4.3.3 Data-Privacy & Cyber-security Risks Handling Protected Health Info
    • 4.3.4 High Up-Front Investment and Change-Management Barriers
  • 4.4 Technological Outlook
  • 4.5 Porter's Five Forces
    • 4.5.1 Threat of New Entrants
    • 4.5.2 Bargaining Power of Buyers
    • 4.5.3 Bargaining Power of Suppliers
    • 4.5.4 Threat of Substitutes
    • 4.5.5 Intensity of Rivalry

5 Market Size & Growth Forecasts (Value, USD)

  • 5.1 By Component
    • 5.1.1 Software
      • 5.1.1.1 Integrated RCM Suite
      • 5.1.1.2 Standalone Modules
    • 5.1.2 Services
      • 5.1.2.1 Outsourced RCM BPO
      • 5.1.2.2 Consulting & Training
  • 5.2 By Deployment
    • 5.2.1 Cloud-based
    • 5.2.2 On-premise
  • 5.3 By Function
    • 5.3.1 Claims & Denial Management
    • 5.3.2 Medical Coding & Billing
    • 5.3.3 Electronic Health Record (Integrated RCM)
    • 5.3.4 Clinical Documentation Improvement (CDI)
    • 5.3.5 Insurance Eligibility Verification
    • 5.3.6 Other Functions (Patient Scheduling, Pricing Transparency)
  • 5.4 By End User
    • 5.4.1 Hospitals
    • 5.4.2 Physician Offices & Clinics
    • 5.4.3 Ambulatory Surgery Centers
    • 5.4.4 Laboratories
    • 5.4.5 Diagnostic Imaging Centers
    • 5.4.6 Other End Users
  • 5.5 By Specialty
    • 5.5.1 Radiology
    • 5.5.2 Oncology
    • 5.5.3 Cardiology
    • 5.5.4 Pathology
    • 5.5.5 Multi-specialty & Others
  • 5.6 Geography
    • 5.6.1 North America
      • 5.6.1.1 United States
      • 5.6.1.2 Canada
      • 5.6.1.3 Mexico
    • 5.6.2 Europe
      • 5.6.2.1 Germany
      • 5.6.2.2 United Kingdom
      • 5.6.2.3 France
      • 5.6.2.4 Italy
      • 5.6.2.5 Spain
      • 5.6.2.6 Rest of Europe
    • 5.6.3 Asia-Pacific
      • 5.6.3.1 China
      • 5.6.3.2 Japan
      • 5.6.3.3 India
      • 5.6.3.4 Australia
      • 5.6.3.5 South Korea
      • 5.6.3.6 Rest of Asia-Pacific
    • 5.6.4 Middle East and Africa
      • 5.6.4.1 GCC
      • 5.6.4.2 South Africa
      • 5.6.4.3 Rest of Middle East and Africa
    • 5.6.5 South America
      • 5.6.5.1 Brazil
      • 5.6.5.2 Argentina
      • 5.6.5.3 Rest of South America

6 Competitive Landscape

  • 6.1 Market Concentration
  • 6.2 Market Share Analysis
  • 6.3 Company Profiles (includes Global level Overview, Market level overview, Core Business Segments, Financials, Headcount, Key Information, Market Rank, Market Share, Products and Services, and analysis of Recent Developments)
    • 6.3.1 Optum (UnitedHealth Group)
    • 6.3.2 R1 RCM Inc.
    • 6.3.3 Conifer Health Solutions
    • 6.3.4 Cognizant (Trizetto)
    • 6.3.5 athenahealth
    • 6.3.6 Oracle Cerner
    • 6.3.7 Epic Systems
    • 6.3.8 Veradigm LLC
    • 6.3.9 Solventum
    • 6.3.10 GeBBS Healthcare
    • 6.3.11 MCKESSON Corporation
    • 6.3.12 Accenture Health
    • 6.3.13 Infosys Limited
    • 6.3.14 Med-Metrix
    • 6.3.15 Access Healthcare
    • 6.3.16 Conduent
    • 6.3.17 eClinicalWorks
    • 6.3.18 XIFIN
    • 6.3.19 Quest Diagnostics RCM
    • 6.3.20 HCLTech Healthcare

7 Market Opportunities & Future Outlook

  • 7.1 White-space & Unmet-Need Assessment