From Innovation to Affordability: A Conceptual Framework Linking Insurtech Capability to Patient Financial Outcomes

Healthcare affordability remains a significant concern because insured patients may still face substantial out-of-pocket (OOP) expenses arising from deductibles, copayments, uncovered services, and complex billing. This conceptual study develops a framework explaining how Insurtech Capability may contribute to Patient Financial Outcomes through Patient Financial Navigation and Benefit Optimization. Drawing on Dynamic Capabilities Theory, the Information Systems Success Model, Service-Dominant Logic, and the financial toxicity perspective, the framework defines Insurtech Capability through five dimensions: data integration and interoperability, analytics and decision support, process automation, digital financial engagement, and privacy, security, and governance. Interoperability and Organizational Integration are treated as enabling conditions, while Health-Insurance Literacy is a patient-level boundary condition. Six propositions describe the proposed direct, mediated, and moderating relationships. The framework distinguishes actual OOP expense reduction from cost predictability, reduced administrative burden, and reduced financial distress. It also recognizes that plan design, provider prices, network restrictions, and clinical requirements may constrain savings. The contribution is an integrated, patient-centered explanation of how digital insurance resources might translate into financial value. Because the framework is conceptual, its propositions require empirical testing before any causal or affordability effect can be established.