Effects of payer-provider automation technologies on operational performance of medical insurance providers in Nairobi City County, Kenya
Date
2024
Authors
Muiru, H. M.
Journal Title
Journal ISSN
Volume Title
Publisher
Strathmore University
Abstract
In the face of rising competition in the health insurance sector, insurers are under increasing pressure to adapt and evolve their payer capabilities. The change towards a patient-first system, spurred by technological improvements and shifting customer expectations in the midst of medical inflation, has necessitated an examination of and transformation of insurers' operational. Health insurance providers are actively embracing payer-provider automated technologies to automate their operations, reduce administrative burdens, minimize errors, reduce risk and achieve significant improvements in operational efficiency. Despite the ongoing transformation in the insurance sector, there is limited empirical evidence on the effect of payer provider automation technologies on medical insurance operational performance. The aim of this dissertation was to bridge the identified empirical gap by investigating the effect of payer provider automation technologies on medical insurance providers operational performance in Kenya. In addressing this, the researcher observed the objectives of determining the effect of electronic data interchange platforms, claims processing automation systems, mobile patient apps and online portals payer provider automation technologies on medical insurance providers operational performance in Kenya. The beneficiaries of such a study span various stakeholders, including; the government, the health insurance sector players, the general public and academia. This study was anchored on three theories; the Diffusion of Innovation Model to highlight the stages via which technology diffuses through organizations and is eventually accepted to assist operational performance. The Technological Acceptance Model is used to explain the acceptance behavior of firms that embrace technology to enhance operational performance. Lastly, the Dynamic Capabilities Theory is instrumental in explaining and expounding on the dynamic nature organizations utilize both the external and internal resources to ensure optimal operational performance. Moreover, the study was based on a positivism research philosophy since it aligns with the core concepts and approaches that the study is anchored on. A correlational research design was used in this study. The study population comprised of forty-five (45) medical insurance providers in Kenya licensed by the Insurance Regulatory Authority as at December, 2022. The unit of observation was the senior management staff from different departments of the medical insurance providers. The departments in question are: claims, information technology, operations, general managers/ heads of departments and managing directors/executive officers. The sample size of the study was 244 senior management staff of the 45 medical insurance providers. As for data analysis and presentation, the data was analyzed using SPSS software. Descriptive and inferential statistics including correlation and multiple regression analysis was used to analyze quantitative data. The results of the regression analysis show that the effects of electronic data interchange, automation of the claims process, mobile patient applications, and online portals are statistically significant. Based on its findings, the study concluded that Kenyan medical insurance providers' operational performance is influenced by their adopted innovations since client preferences and business demands are constantly changing and that innovation uptake helps businesses gain a competitive edge. The results of the regression analysis show that the effects of electronic data interchange, automation of the claims process, mobile patient applications, and online portals are statistically significant. Finally, the study concludes that, payer provider automation technologies have been embraced by medical insurance providers, improving the organization's operational performance and increasing sales income, market share, and customer satisfaction in service delivery.
Key words: Electronic Data Interchange, Automation of The Claims Process, Mobile Patient Applications, Online Portals, Medical Insurance Providers, Operational Performance
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Full - text thesis
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Citation
Muiru, H. M. (2024). Effects of payer-provider automation technologies on operational performance of medical insurance providers in Nairobi City County, Kenya [Strathmore University]. http://hdl.handle.net/11071/15549