The strategic role of inter-coopetition in driving hospital sustainability under rising healthcare costs

Abstract

Rising healthcare costs continue to threaten the long-term viability of hospitals, particularly private general hospitals in Indonesia. This study aims to examine the strategic role of Inter-Coopetition Strategy (SKA) in strengthening hospital business sustainability (KB), while also analysing the effects of Integrated Preventive Care (PPT), Value-Based Care Orientation (OPN), and Digital Capability (KDD) under increasing financial pressures. A concurrent mixed-methods design was adopted. Quantitative data were obtained from 180 hospital managers through structured surveys and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). To complement and contextualise the statistical results, qualitative insights were gathered through semi-structured interviews with selected hospital leaders.The results demonstrate that OPN and SKA have significant positive direct effects on KB, while SKA mediates the relationships between PPT and OPN with KB. Digital capability (KDD) also emerges as a strong determinant of sustainability, indicating the essential role of technology in improving operational efficiency and organisational resilience. Although the direct effect of PPT on KB was relatively weak quantitatively, qualitative evidence confirms its strategic relevance, suggesting that preventive care contributes most effectively to sustainability when implemented within collaborative hospital networks. The study concludes that inter-coopetition serves as a critical mechanism for enhancing hospital business sustainability in an increasingly costly healthcare environment. When combined with value-based care, preventive services, and digital capabilities, SKA enables hospitals to achieve integrated pathways toward resilience and performance continuity. The findings provide actionable guidance for hospital leaders to embed preventive and value-driven care into strategic planning, strengthen inter-hospital collaborative–competitive arrangements, and invest in digital infrastructure to support agile and data-informed decision-making. At the policy level, the results highlight the need for aligned incentives and regulatory support—particularly within the national health insurance system—to ensure the financial and operational sustainability of hospital services.