Abstract:
Health insurance is still underutilized, despite a rise in public awareness, interest, and
consideration after the COVID-19 pandemic. It seems that a wide range of attractive
plans are being offered to the general populace by both public and private companies.
The reason Health Insurance (HI) companies are not succeeding in achieving the HI
penetration has now becomes an area of study. A population’s attitude regarding health
insurance may not be fully understood by stakeholders. According to a review of the
literature, there are numerous problems with the health insurance market, including lack
of trust, out-of-pocket expenses, and lack of knowledge about available facilities.
Insurance market players can address these problems through CE in HI sector as
CE has become strategic tool for facilitating satisfaction, repurchase intention, loyalty,
co-creation, repatronage intention, and consequently firm performance in the service
context. (Agyei et al., 2020; Dessart et al., 2015; Harrigan et al., 2017; Hollebeek,
2011a; Islam & Rahman, 2016). CE has been extensively researched across other
service sectors such as banking (Islam et al., 2020), telecommunications (Mishra et al.,
2020), and hospitality (Durna et al., 2015; Yen et al., 2020); however, its strategic role
in the Indian health insurance industry domain remains underexplored. This study
aims to fill that research gap by developing and validating a context-specific customer
engagement model for the Indian health insurance sector.
The research addresses four key objectives: (1) identifying the major issues in the
Indian HI industry, (2) assessing the current level of CE, (3) determining the critical
factors that influence CE, and (4) proposing an empirically validated CE framework
tailored to India’s unique economic landscape. A descriptive and causal approach is
adopted. Initially, expert opinions and a literature review informed the identification of
CE dimensions. Fuzzy AHP was used to determine the level of customer engagement,
while a structured survey of health insurance policyholders helped collect primary
data. Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM)
techniques were employed to test hypotheses and validate the model.
The present study seeks to examine, with the help of proposed model, the influence
of various strategies (AI chatbots, gamification, innovation, and referral rewards) on CE
which in turn leads to repurchase intention. The Stimulus-Organism-Response theory
has been adopted as the theoretical background to justify the proposed model of the
study. After carrying out an extensive literature review on CE and health insurance
sector, this study adopted a quantitative cross-sectional survey design for empirically
investigating the model. Two self-administered questionnaire surveys were conducted
from experts and customers having health insurance respectively in NCR. Only those
customers were taken as respondents who had HI from at least 3 years. A total of 396
valid responses were taken for statistical analysis (PLS-SEM) for the study and to study
iv
the level of CE, total of 25 responses were taken from HI industry experts for Analytical
Hierarchy Process (Multi-Criteria Decision Making) technique.
Findings of the study demonstrated that CE has a significant influence on repurchase
intentions. Strategies such as digital interactivity (e.g., AI chatbots), referral reward
programs, gamification, and service innovation emerged as key enablers of customer
engagement. The study emphasizes the need for customized engagement strategies that
reflect India’s cultural and demographic nuances.
The key contribution of the present study is the formulation of a robust model that
explains the CE concept in HI industry and explains that various strategies including
AI chatbots, gamification, innovation, and referral rewards drive CE which in turn has
a positive influence on repurchase intention. Moreover, the systematic literature review
on CE and the various issues in health insurance sector provides insights for researcher
regarding future research directions. By offering empirical evidence and managerial
recommendations, the study contributes to both the academic literature, and industry
practice, helping to solve the various issues in the health insurance industry.