Citation:

Daniel Wambua Mulinge, Prof. Cyrus Iraya. "Institutional Determinants and Financial Sustainability in Social Health Insurance Schemes: A Critical Review" International Research Journal of Economics and Management Studies, Vol. 4, No. 4, pp. 288-290, 2025.

Abstract:

The financial sustainability of Social Health Insurance Schemes (SHIS), especially in developing economies, remains a significant challenge. This study examines the impact of governance structures, regulatory frameworks, and organizational culture on the financial sustainability of SHIS through a systematic review of theoretical and empirical literature. The analysis is grounded on four diverse theoretical perspectives: The Agency Theory is a framework that investigates principal-agent conflicts and their underlying alignment mechanisms; The Stewardship Theory emphasizes the intrinsic motivation of managers to act as organizational stewards; The Resource Dependence Theory is a strategic approach to managing external resources; as well as Institutional Theory, which explains organizational compliance with external norms for legitimacy. The review emphasizes the importance of robust governance mechanisms, adaptive regulatory environments, and stakeholder engagement for long-term viability. However, political interference and rigid institutional frameworks can significantly hinder sustainability efforts. The study highlights significant research gaps in developing nations' context-specific studies and suggests future research on mediating variables like digital transformation and leadership styles.

References:

[1] Schmitt, T., A. Haarmann, and M. Shaikh. 2023. “Strengthening Health System Governance in Germany: Looking Back, Planning Ahead.” Health Economics, Policy and Law 18 (1): 14–31.
[2] Meyer, John W., and Brian Rowan. 1977. Institutional organizations: Formal structure as myth and ceremony. American Journal of Sociology 83: 340–63.
[3] Donaldson, L., & Davis, J. H. (1991). Stewardship theory or agency theory: CEO governance and shareholder returns. Australian Journal of Management, 16(1), 49-64.
[4] Pfeffer, J., & Salancik, G. (2015). External control of organizations—Resource dependence perspective. In Organizational behavior 2, 355-370. Routledge.
[5] Chaabo, N. (2021). The regulatory compliance system: Impact of AML/CFT implementation on the financial performance of Lebanese banks. Journal of Contemporary Research in Business Administration and Economic Sciences. 1(2), 23-37.
[6] Cheboi, L. T., Asienga, I., & Otuya, R. (2024). Financial structure and financial sustainability of Microfinance Institutions in Kenya. Journal of Management Science (JMAS), 7(2), 301-308.
[7] Choi, P. M. S., Choi, J. H., Chung, C. Y., & An, Y. J. (2020). Corporate governance and capital structure: Evidence from sustainable institutional ownership. Sustainability, 12(10), 41-90.
[8] Donaldson, Lex, and James H. Davis. 1991. Stewardship Theory or Agency Theory: CEO Governance and Shareholder Returns. Australian Journal of Management, 16: 49–64.
[9] Doshiro, M. U., Ibrahim, H. V., & Usman, T. G. (2023). Structural determinants of financial sustainability of listed financial companies in Nigeria. FUDMA Journal of Accounting and Finance Research [FUJAFR], 1(1), 49-64.
[10] Gerged, A. M., Yao, S., & Albitar, K. (2022). Board composition, ownership structure, and financial distress: insights from UK FTSE 350. Corporate Governance: The International Journal of Business in Society, 23(3), 628-649.
[11] Githaiga, P. N. (2022). Revenue diversification and financial sustainability of microfinance institutions. Asian Journal of Accounting Research, 7(1), 31-43.
[12] Isayas, Y. N. (2021). Financial distress and its determinants: Evidence from insurance companies in Ethiopia. Cogent Business and Management, 8(1). https://doi.org/10.1080/23311975.2021.1951110
[13] Jensen, M.C., Meckling, W.H. (1976), Theory of the firm: Managerial behavior, agency costs, and ownership structure. Journal of Financial Economics, 3(4), 305-360.
[14] Judijanto, L., Nurdiani, T. W., Ningsih, T. W., & Ryketeng, M. (2023). The Effect of Regulatory Compliance and Digital Audit Adoption on Auditor Performance and Financial Reporting Accuracy in Indonesia. The ES Accounting and Finance, 2(01), 77-86.
[15] Kılıç, M., Gurler, H. E., Kaya, A., & Lee, C. W. (2022). The impact of sustainability performance on financial performance: Does firm size matter? Evidence from Turkey and South Korea. Sustainability, 14(24), 16695.
[16] Riaz, A., Hussain, M. M., Raza, H., & Khan, A. (2023). Board Attributes and Firm Performance of Non-Financial Listed Firms in Pakistan: Role of Ownership Structure. Journal of Business and Social Review in Emerging Economies, 9(3), 381-392.

Keywords:

Financial Sustainability, Institutional Determinants, Social Health Insurance, Governance, Regulatory Frameworks, Developing Economies.