The Mediation Effect of Service Innovation on the Relationship Between Promotional Strategies and Market Share in Medical Schemes, South Africa
DOI:
https://doi.org/10.55578/jift.2506.004Keywords:
Healthcare Funders, Market Share, Mediating Effect, Medical Schemes, Outsourcing Marketing Services, Promotional Strategies, Quantitative Analysis, Service InnovationAbstract
Orientation: The dynamic global healthcare landscape requires ongoing adaptation and innovation. Service innovation (SI) is pivotal for healthcare funders and providers, particularly in medical schemes, where it significantly enhances the effectiveness of promotional strategies (PS) and improves market share (MS).
Research Purpose: This study investigated the mediating effect of service innovation on the relationship between promotional strategies and market share in the private healthcare sector, with a focus on medical scheme beneficiaries in Gauteng, South Africa. It aimed to assess how service innovation amplified the impact of promotional strategies on market share and examined the implications of outsourcing marketing services.
Motivation for the Study: Rising complexity in the healthcare market and the need for medical schemes to attract and retain members amid growing competition drive this study. Understanding how service innovation mediates the relationship between promotional strategies and market share offers insights into optimising marketing efforts for better market penetration.
Research Approach/Design and Method: A quantitative research approach utilising a mediation analysis design was adopted. Data were collected from 260 beneficiaries of medical schemes in Gauteng, South Africa, through snowball sampling. The analysis followed the mediation framework proposed by Baron and Kenny, with additional validation conducted using STATA software, incorporating the approach developed by Zhao, Lynch, and Chen.
Main Findings: Service innovation partially mediates the relationship between promotional strategies and market share, accounting for approximately 12% of the total effect. This finding underscores service innovation's role in enhancing promotional strategies' effectiveness. It indicates that service innovation is a key explanatory mechanism through which promotional efforts contribute to the growth or retention of market share within the healthcare insurance sector.
Practical/Managerial Implications: Integrating service innovation into promotional strategies is crucial for healthcare funders and providers to improve market share. The study also underscores the importance of aligning outsourced marketing services with organisational goals to maximise effectiveness.
Contribution/Value-Add: This research provides empirical evidence on the partial mediation effect of service innovation, offering valuable insights for optimising marketing strategies and addressing challenges in outsourcing marketing services. Thus, it enhances competitive positioning in the healthcare sector.
References
1.Berry, L. L. (2019). Service innovation is urgent in healthcare. Academy of Marketing Science Review, 9(S2), Article 24. https://doi.org/10.1007/s13162-019-00135-x
2.Kelly, C. J., & Young, A. J. (2017). Promoting innovation in healthcare. Future Healthcare Journal, 4(2), 121-125. https://doi.org/10.7861/futurehosp.4-2-121
3.Filip, R., Puscaselu, R. G., Anchidin-Norocel, L., et al. (2022). Global challenges to public health care systems during the COVID-19 pandemic: A review of pandemic measures and problems. Journal of Personalized Medicine, 12(8), 1295. https://doi.org/10.3390/jpm12081295
4.Nabyonga-Orem, J., Christmals, C. D., Addai, K. F., et al. (2023). The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: A scoping review. Journal of Global Health, 13, 04153. https://doi.org/10.7189/jogh.13.04153
5.Sriram, V., Yilmaz, V., Kaur, S., et al. (2024). The role of private healthcare sector actors in health service delivery and financing policy processes in low- and middle-income countries: A scoping review. BMJ Global Health, 8(Suppl 5), e013408. https://doi.org/10.1136/bmjgh-2023-013408
6.Clarke, J. L., Bourn, S., Skoufalos, A., et al. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1), 23-30. https://doi.org/10.1089/pop.2016.0076
7.Samal, L., Fu, H. N., Camara, D. S., et al. (2021). Health information technology to improve care for people with multiple chronic conditions. Health Services Research, 56(Suppl 1), 1006. https://doi.org/10.1111/1475-6773.13860
8.Mbunge, E., Batani, J., Gaobotse, G., et al. (2022). Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: A systematic review. Global Health Journal, 6(2), 102-113. https://doi.org/10.1016/j.glohj.2022.03.001
9.Sussex, J., Smith, J., & Wu, F. M. (2024). Service innovations for people with multiple long-term conditions: Reflections of a rapid evaluation team. Health and Social Care Delivery Research, 12(15). https://doi.org/10.3310/PTRU7108
10.Alexandrescu, M.-B., & Milandru, M. (2018). Promotion as a form of communication of the marketing strategy. Land Forces Academy Review, 23(4), 268-274. https://doi.org/10.2478/raft-2018-0033
11.Bondarenko, V., & Vyshnivska, B. (2023). Promotional marketing as a method of increasing sales. Three Seas Economic Journal, 4(2), 21-28. https://doi.org/10.30525/2661-5150/2023-2-3
12.McIntyre, D. (2010). Private sector involvement in funding and providing health care in South Africa: Implications for equity and access to health care. EQUINET Africa. https://www.equinetafrica.org/files/documents/Safe_Ltr_McIntyre.pdf
13.Willie, M. M. (2023). Understanding the dynamics of marketing expenditures in the South African medical scheme industry. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4597902
14.Rammila, D. (2023). Evaluating the potential impact of National Health Insurance on medical scheme members' rights to have access to healthcare services in South Africa. Law, Democracy & Development, 27, 360-391. https://doi.org/10.17159/2077-4907/2023/ldd.v27.14
15.Batra, R., & Keller, K. L. (2016). Integrating marketing communications: New findings, new lessons, and new ideas. Journal of Marketing, 80(6), 122-145. https://doi.org/10.1509/jm.15.0419
16.Kotler, P., & Keller, K. L. (2021). Marketing management (16th ed.). Pearson Education.
17.Snyder, H., Witell, L., & Gustafsson, A. (2020). Service innovation: A new conceptualization and path forward. Journal of Service Research, 23(2), 111-115. https://doi.org/10.1177/1094670520908929
18.Gallouj, F., & Djellal, F. (Eds.). (2010). The handbook of innovation and services: A multi-disciplinary perspective. Edward Elgar Publishing. https://doi.org/10.4337/9781849803304
19.Prestes Joly, M., Teixeira, J. G., Patr穩cio, L., et al. (2019). Leveraging service design as a multidisciplinary approach to service innovation. Journal of Service Management, 30(6), 681-715. https://doi.org/10.1108/JOSM-07-2017-0178
20.Flessa, S., & Huebner, C. (2021). Innovations in health care-A conceptual framework. International Journal of Environmental Research and Public Health, 18(19), 10026. https://doi.org/10.3390/ijerph181910026
21.Willie, M. (2024). Service innovation theory and its application in healthcare. Journal of Health Care and Developmental Change, 4, 57-65. https://doi.org/10.26480/jhcdc.02.2024.57.65
22.Makgopa, S. S. (2021). The influence of service innovations on profit growth [Master's thesis, University of Pretoria]. https://repository.up.ac.za/bitstream/handle/2263/76068/Makgopa_Influence_2021.pdf
23.Lie Heng, A. T., Augusty Tae Ferdinand, A. T., & Nur Afifah. (2020). Service innovation capability for enhancing marketing performance: A service-dominant logic perspective. Verslas: Teorija ir Praktika, 21(2), 623-632. https://doi.org/10.3846/btp.2020.12163
24.Chen, S.-L., & Chen, K.-L. (2023). The mediating impact of innovation types in the relationship between innovation use theory and market performance. Stats, 7(1), 1-22. https://doi.org/10.3390/stats7010001
25.Jung, S.-U., & Shegai, V. (2023). The impact of digital marketing innovation on firm performance: Mediation by marketing capability and moderation by firm size. Sustainability, 15(7), 5711. https://doi.org/10.3390/su15075711
26.Purcarea, V. L. (2019). The impact of marketing strategies in healthcare systems. Journal of Medicine and Life, 12(2), 93-96. https://doi.org/10.25122/jml-2019-1003
27.Council for Medical Schemes. (2006). Putting members first: Towards better governance of medical schemes: Findings and recommendations of the governance theme project. https://www.medicalschemes.com/files/Presentations%20And%20Reports/FINAL%20GOVERNANCE%20REPORT%20APRIL%202006%20_3_%20_3_.pdf
28.Porter, M. E., & Lee, T. H. (2013). The strategy that will fix healthcare. Harvard Business Review, 91(12), 50-70. https://hbr.org/2013/12/the-strategy-that-will-fix-health-care
29.Rodrigues, L. C., Maccari, E. A., & Lenzi, F. C. (2012). Innovation strategy for business to business market penetration. International Business Research, 5(2), 137-137. https://doi.org/10.5539/ibr.v5n2p137
30.Varadarajan, R. (2018). Innovation, innovation strategy, and strategic innovation. In Innovation and strategy (pp. 143-166). Emerald Publishing Limited. https://doi.org/10.1108/S1548-643520180000015007
31.Dumitrescu, L., Stanciu, O., Tichindelean, M., et al. (2011). Pursuing a customer-driven approach for innovation and marketing excellence. Studies in Business and Economics, 16(2), 19-26.
32.Zhang, X., & Saltman, R. (2022). Impact of electronic health record interoperability on telehealth service outcomes. JMIR Medical Informatics, 10(1), e31837. https://doi.org/10.2196/31837
33.Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
34.Nwachukwu, C. E., & Hieu, V. M. (2022). Service innovation, marketing innovation, and customer satisfaction: Moderating role of competitive intensity. SAGE Open, 12(2), 21582440221082146. https://doi.org/10.1177/21582440221082146
35.Kankam-Kwarteng, C., Osei, F., Asante-Gyabaah, G., & Ferkah, K. A. (2022). Mediation role of service innovation in the effects of knowledge creation on marketing performance of restaurant. Technium Social Sciences Journal, 27, 620-638. https://doi.org/10.47577/tssj.v27i1.5338
36.Medina, C., & Ruf穩n, R. (2009). The mediating effect of innovation in the relationship between retailers' strategic orientations and performance. International Journal of Retail & Distribution Management, 37(7), 629-655. https://doi.org/10.1108/09590550910964639
37.Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93-115. https://doi.org/10.1037/a0022658
38.Fairchild, A. J., & McDaniel, H. L. (2017). Best (but oft-forgotten) practices: Mediation analysis. The American Journal of Clinical Nutrition, 105(6), 1259-1271. https://doi.org/10.3945/ajcn.117.152546
39.Lapointe-Shaw, L., Bouck, Z., Howell, N. A., et al. (2018). Mediation analysis with a time-to-event outcome: A review of use and reporting in healthcare research. BMC Medical Research Methodology, 18, Article 118. https://doi.org/10.1186/s12874-018-0598-0
40.Rijnhart, J. J. M., Lamp, S. J., Valente, M. J., et al. (2021). Mediation analysis methods used in observational research: A scoping review and recommendations. BMC Medical Research Methodology, 21, Article 226. https://doi.org/10.1186/s12874-021-01449-2
41.Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182. https://doi.org/10.1037/0022-3514.51.6.1173
42.Naderifar, M., Goli, H., & Ghaljaei, F. (2017). Snowball sampling: A purposeful method of sampling in qualitative research. Strides in Development of Medical Education, 14(3), e67670. https://doi.org/10.5812/sdme.67670
43.Zhao, X., Lynch Jr, J. G., & Chen, Q. (2010). Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of Consumer Research, 37(2), 197-206. https://doi.org/10.1086/651257
44.Borowski, P. F. (2021). Innovation strategy on the example of companies using bamboo. Journal of Innovation and Entrepreneurship, 10(1), 1-17. https://doi.org/10.1186/s13731-020-00144-2
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