Artificial intelligence as a tool for improving access, cost efficiency and service delivery in medical aid organisations in South Africa: case study of 54 Healthcare (Pty).

Abstract

Substantial challenges related to poor medical aid accessibility, rising operational and administrative costs, and inefficient delivery of quality and effective service characterise health insurance in South Africa. Adoption of Artificial Intelligence technologies has established significant opportunities for Medical Aid organisations to enhance access to medical insurance, cost efficiency, and real-time delivery of quality services in medical aid provision. This study examines the role of AI in improving access, cost efficiency, and service delivery within health insurance organisations in South Africa, using the case of 54 Healthcare. Previous research revealed that AI significantly influences health insurance outcomes across the globe. The Technology Acceptance Model (TAM), the Diffusion of Innovations model (DOI), and the Resource-Based View (RBV) provided a strong theoretical foundation for this study. However, a gap exists in AI adoption specifically in Medical Aid industries in developing countries. This study adopted a quantitative research approach based on a positivist philosophy and a deductive case study approach to generalise findings from 54 Healthcare. The data were collected using structured closed-ended questionnaires administered via Google Forms from 50 participants comprising 23 employees and 27 members of 54 Healthcare. Data were analysed using descriptive statistics and regression analysis administered using SPSS. The results established that there is a statistically significant and positive relationship between AI adoption and the three study variables, which consisted of access to medical aid, cost efficiency, and service delivery. In conclusion, the study found out that AI adoption is a key strategic resource necessary for enhancing access, cost efficiency, and service delivery in Medical Aid organisations in South Africa. The study recommended that more resources be injected into AI adoption, alignment with Education 5.0, capacity building, and governance of AI for sustainable service delivery