Configurations of Essential Factors Promoting China’s Commercial Health Insurance: A Qualitative Comparative Analysis Based on Technology-Organization-Environment Framework

Background: With the improvement in the living standards, China’s health insurance under the social security system cannot satisfy people's diversified and high-level demands. Therefore, it is necessary to promote commercial health insurance (CHI). This study identifies driving paths of CHI in China from configuration perspective. Methods This study innovatively constructs an analysis framework based on the Technology-Organization-Environment theory to investigate the driving path of China's commercial health insurance. Using the data of 31 provincial regions of China in 2018, the fuzzy-set Qualitative Comparative Analysis (QCA) is employed for configuration analysis. For the robustness analysis of necessary condition, we also adopt the Necessary Condition Analysis. Results Three main findings are discovered. First, there is no necessary relationship between any condition and high or not-high performance of CHI and any condition. Nevertheless, there are three sufficient configurations, TOE strategy, GA-EA-CD strategy, and dual EA-CD strategy, to achieve high performance, and another three, TMC-EA-CD strategy, TI-EA strategy, and TI-TMC-EA strategy, to reach not-high performance. Second, technological conditions (TI and TMC) and EA are relatively more important than other conditions. Third, it is confirmed that the financial expenditure of government departments has a negative effect on the development of commercial health insurance. Conclusion There are configurations or pathways to achieve high or not-high performance of promoting CHI and key factors are identified successfully. Each region should choose the driving path suitable for itself, instead of making homogenization policies and replicating policies of regions with high performance. Besides, TC and EA as key factors should be overcome. Finally, the governments should formulate policies to systematically evaluate social insurance and CHI simultaneously and promote their coordinated development.