2024, Vol. 7, Issue 2

author(s)
K Murugan and M Bharath

abstract
This research offers valuable strategic insights and a perspective on the business model of health insurance as a means of funding healthcare. Both primary data from expert interviews and secondary data are utilized to examine the total disease burden and healthcare industry trends in India, as well as monitor healthcare financing via health insurance. In order to determine the key factors for success and to understand the business model in the health insurance sector, 27 experts in healthcare, insurance, and strategic management were interviewed through phone and in-person meetings. The results of the study indicate that the expansion of health insurance as a means of healthcare funding in India has faced ongoing challenges and been influenced by various changes in the health insurance and healthcare sector in the past ten years. Insurance companies often struggle with a high incurred claim ratio, which is a significant challenge they must address. We observe a high level of competition in the Indian health insurance sector, and believe that concentrating on key success factors can give insurance firms a competitive edge. The health insurance industry has a distinctive business model, which includes different structures and mainly involves strategic decisions and outcomes. This article outlines the six crucial success factors for competition in the health insurance industry, based on insights from healthcare and health insurance experts and the resource-based view literature. We additionally outline five strategic decisions that can enhance the financial performance and secure a lasting competitive edge for health insurance firms. Our suggestion is for insurance companies to create a new and creative business strategy focused on reducing the claim ratio while also boosting customer willingness to pay. Insurance companies should concentrate on the six critical success factors and make investments to boost customer willingness to pay and lower claim ratios.