Consumers’ Purchase Intention Toward Online Health Insurance in Saudi Arabia

Literature reported a dearth of research on Online Health Insurance in Saudi Arabia. The purpose of this paper thus is to understand the antecedents of Consumers’ Purchase Intention toward Online Health Insurance in Saudi Arabia. The paper drew data from 355 Saudi Arabian internet buying communities. The paper used Smart-PLS 3 to analyze the data. The findings show that attitude, perceived behavioral control, subjective norms and perceived trust have significant positive influences on purchase intention toward online health insurance in Saudi Arabia. However, the relationship between religiosity and purchase intention toward online health insurance was not supported. Various theoretical and managerial implications of these findings were discussed.


Introduction
Saudi Arabia, which is in the southeast of the Asian peninsula, has a population of around 30 million people, more than 6 million of whom are not Saudi (Hobbs, 2021). Overall, the nation has established itself as tech-friendly, particularly in light of its 2016-launched National e-Government Program (Godart et al., 2019). The central government of Saudi Arabia is attempting to use technology to increase the efficacy and efficiency of the public sector, provide better and faster public services, and ensure accurate data gathering and distribution (Alahmadi, Mansour, Martin, & Atkinson, 2021). Salkowitz (2018), who contends that Saudi Arabia is youthful (developing) and extremely wealthy, supports this point of view by saying that country uses technology well and benefits from it. It claims to have resources that all citizens can access. In light of this, Goddard et al. (2019) point out notable variations within the Saudi community concerning the adoption of technology for fundamental daily tasks like online insurance services.
Saudi Arabia has a significant digital divide between those who can access and use technology and others who lack the resources or expertise to do so. However, the development of internet technology is viewed as having the potential to alter Saudi society; It is thought that the Internet makes social networking, online shopping, and information processing and exchange possible (Alrashid, 2012). It has been observed that Saudi Arabia is investing more money in information and communication technology (ICT). Business Monitor International (BMI, 2009(BMI, , 2012 highlighted changes in wireless technology in Saudi Arabia and found that the Saudi government was responsible for an astounding 40% of ICT spending. These developments need scientifically evaluate the effects on specific consumers in Saudi Arabia in comparison to other developed and emerging nations. A growing interest in the impact of culture on customer attitudes toward service use and adoption contributes to the interest in such research that the consumer participates in (Donthu & Yoo, 1998;Lin, 2010;Zhang & Neelangkavil, 1997). Strong cultural influences on consumer decisions are facilitated by reducing the impact of geographic limits, the ambition of consumer service companies to grow global markets, and support for consumer culture (Chao & Spillane, 2020;Hofstede & Bond, 1984). The knowledge that the number of Internet users in Saudi Arabia is continually rising has given such study even more momentum. A table from the World Internet Users and Population Stats was cited by Al Rasheed and Mirza in 2019. According to research by the Arab Advisors Group, 59% of Saudi Arabia's internet users make purchases online. This means that 52.7% of the country's population uses the internet. However, experts and academics are currently working to comprehend Saudi customers' online behavior better (Al Rasheed & Mirza, 2019). Previous studies have looked at how web technology is used in Saudi Arabia. Al-Maghrabi (2010), for instance, looked at the variables that influence online shopping. Al-Shohaib and Frederick (2010) looked into how acceptance is affected by the Internet. Al-Somali, Gholami and Clegg (2009) looked into the acceptability of internet banking. Alatawy and NoorAlam (2021) investigated the factors influencing internet use while buying luxury brands, and Almogbil (2015) investigated the difficulties of embracing online banking. Few studies have looked at consumer adoption of technology in Saudi Arabia to date, and none have thoroughly looked at customer purchase intentions for online health insurance. To close this gap, a large cross-sectional sample of Saudi consumers was used in this study to explore consumer purchase intentions, perceived behavioral control, subjective norms, and relationships with religion about online health insurance. This study's effort to expand the theory of planned behavior by including religion as a factor influencing online health insurance in Saudi Arabia is what makes it particularly distinctive and fascinating.
This study's primary objective is to investigate the current purchase intention of Saudi consumers of online health insurance services and to establish their attitudes towards, and adoption of, online health insurance services. From this, several research objectives emerge: 1) To investigate the impact of attitude on Consumers' purchase intention toward online health insurance in Saudi Arabia.
2) To examine the effect of perceived behavioral control on Consumers' purchase intention toward online health insurance in Saudi Arabia.
3) To determine the effect of subjective norms on Consumers' purchase intention toward online health insurance in Saudi Arabia. 4) To test the effect of perceived trust on Consumers' purchase intention toward online health insurance in Saudi Arabia.

5)
To test the effect of religiosity on Consumers' purchase intention toward online health insurance in Saudi Arabia.

Literature Review
This framework was based on the 1980-introduced plan Behavior Theory (TPB). This idea has been put forth to define actions that an individual has influence over. In industries like public relations, healthcare, and advertising, TPB theory has been used to explore the connections between attitudes, beliefs, behavioral intentions, and behavior. According to this theory, behavioral intentions are influenced by behavioral attitudes, subjective standards, and perceptual behavior control (PBC) (Ajzen, 1980;Fishbein, 1980;Taylor & Todd, 1995a). When deciding whether to buy an internet insurance service, keep this in mind. This is crucial when it's necessary to link behavioral intents (as stated in the TPB) with behavioral influences before a transaction is made. TPB, in the words of Ajzen (1991), includes a variety of elements that collectively demonstrate the actual influence that an individual has over customer behavior. Studies in the context of the Internet frequently incorporate TPB theory. Since its inception, TPB has been utilized in many technology adoption contexts to forecast and explain both actual self-reported behavior and individual behavioral intents from both management and consumer perspectives (Chen, 2005;Chen et al., 2007;Troise, et al., 2020). In previous research (Armitage & Conner, 2001;Montano & Kasprzyk, 2018), TPB has received substantial validation. It is a useful tool for understanding customers' intentional behavior when they shop online. It is demonstrated that there (Alam & Sayuti, 2011;Shim et al., 2001). TPB has also been used in online activities involving information about purchases (Alam & Sayuti, 2011;Huang et al., 2011;Oteng-Peprah et al., 2020). The research study model does, however, suggest five factors that affect how Saudi clients perceive online health insurance services. The components and theories that potentially enhance Saudi consumers' perceptions of and real experiences with online health insurance services are described in more detail in the subheadings below. The research's conceptual framework is depicted in Figure 1. amount of effort necessary to carry out behavior and how hard a person wants to work. Limayem, Khalifa, and Frini (2000) examined elements influencing online purchases more recently and discovered that PBC is a factor in determining online shoppers' intentions. According to Keane et al. (2004), their findings concur with those of Limayem, Khalifa and Frini (2010). According to Taylor and Todd (1995), adopters' self-assurance in their capacity to employ innovation highlights how having control has a good connotation. Similar to how PBC is identified as a factor influencing customer propensity to use online services by Herrero Crespo and Del Bosque (2010). According to Huang et al. (2011), PBC affects customer behavioral intentions favorably in online situations. Delafrooz, Paim and Khatibi (2011) demonstrate how PBC can impact consumers' inclinations to make online purchases favorably. Similar to Alam and Sayuti (2011), the results demonstrate how attitudes, subjective norms, and PBC influence online buying intentions. PBC and the intention to use the Internet to acquire online services are related in two ways. In the first place, it might enhance behavioral intentions, and in the second, it might enhance purchasing intentions (Vasquez et al., 2019). TPB points out that PBC affects a person's behavioral goals. When a person thinks there is a severe situational dysfunction associated with conduct, their confidence in that behavior is reduced. Individual intentions are thereby diminished to prevent disappointment (Sembada & Koay, 2021). It might be viewed as a barrier to utilizing internet insurance services. PBC can therefore significantly influence a customer's decision to buy when they use the Internet to buy insurance goods. For instance, a customer may be more inclined to use these services if they have the requisite knowledge to buy health insurance online. PBC can therefore significantly influence the inclinations of customers to make purchases. As a result, the following hypothesis is advanced: Hypothesis 2: When using the internet for purchasing health insurance products, perceived behavioral control (PBC) will have a significant impact on customers' purchase intention.

The Impact of Subjective Norms on Online Health Insurance Purchase Intention
In this context, it is important to define precisely what is meant by the term "subjective norms," which refers to people's impressions of the social normative pressures imposed by their families, friends, classmates, and other people's beliefs (Taylor & Todd, 1995). Social influence, according to subjective standards, is a person's sense of what people who are significant to him believe his behavior should be (Fishbein & Ajzen, 1975). The likelihood that the important individuals or groups making the recommendation will concur with or disagree with a certain course of action is commonly characterized by the phrase "normative belief" (Ajzen, 1991). It has been discovered that subjective norms are connected to prominent sites of behavior-related control (Ajzen, 1991). A justification for the influence of subjective standards on intention is that if we think a significant other is encouraging us to perform a certain activity, we may decide to do so (Davis & Venkatesh, 2000). Normative views, according to Taylor and Todd (1995), are personal perceptions that are influenced by the opinions of important persons (parents, peers, friends). George (2004)  On the other hand, some researchers contend that attitudes regarding online services and past experiences together with intentions to shop online are the main determinants of intentions, with little to no impact from subjective norms (Huang et al., 2011). Subjective norms are used in this study to describe how consumers view using online services and how that impression is shaped by the views of reference groups (family, colleagues, friends, etc.). Prior studies have demonstrated that subjective norms significantly influence the behavioral intentions of customers (Liang et al., 2019). The decision to use online services, including making purchases, is influenced by family and friends in the context of online health insurance. On the suggestion of relatives, friends, or coworkers, people who desire to get health insurance online can be persuaded to use online services. Bay et al. (2019) found that customers of online services are strongly influenced by recommendations from friends and family when making purchases. Theoretically, this can conclude that subjective norms are likely to significantly influence purchasing intention. thus, the following hypothesis is anticipated: Hypothesis 3: Subjective Norms will have a significant impact on customer purchase intention when using the internet to purchase health insurance products.

The Role of Perceived Trust in Online Health Insurance Purchase Intention
Understanding perceived trust is a fundamental relational term that has been characterized in various ways by discipline scholars (McKnight & Chevron, 2002). Each field evaluates trust in light of its standards. For instance, sociologists link trust to the social structure while psychologists consider it a personal quality (Lewicki et al., 2006). The belief that their needs will be addressed in the future as a result of another party's activities is ijms.ccsenet.org International Journal of Marketing Studies Vol. 14, No. 2;2022 referred to as perceived trust (Lewicki et al., 2006). As a result, in the context of online markets, it can be characterized as a seller's capacity for persuasion and perceptions of that seller's likely future behavior (Ganesan, 1994). According to Fung and Lee (1999), a new definition of trust is the readiness to accept different aspects of another person fairness, goodness, power, ability, mercy, integrity, and predictability. The frequent use of the website frequently results in perceived trust. If their expectations are met during their visit, more experienced users will believe the information offered to them (Bart et al., 2005). According to Lloyd et al.'s (2010) preliminary research on a conceptual model of purchase intent and perceived trust, trust is significantly correlated with intention. Purchase intent can be positively correlated with online trust. This is reiterated by Izquierdo-Yusta and Schultz (2011) , trust can impact a consumer's decision to buy. Therefore, the following hypothesis is formulated: Hypothesis 4: perceived Trust will have a significant impact on customer purchase intention when using the internet to purchase health insurance products.

The Role of Religiosity in Online Health Insurance Purchase Intention
The degree to which a person upholds and incorporates their religious principles, values and practices into their daily lives is referred to as their level of religious commitment (Adi & Adawiyah, 2018). It is crucial to understand that Muhammad (PBUH) is considered to be Allah's messenger and that there is only one God (prophet). Islam's doctrines are derived from the Quran and the Hadith, two different books (the recorded saying of and deeds of Muhammad, PBUH). Muslims contend that Islam is a whole system and way of life rather than merely a religion. It offers instructions for the spiritual, mental, physical, and, to some extent, the daily life of its adherents. Islam is predicated on two core convictions: faith in Allah and faith in the hereafter. This means that Muslims think their actions and conduct in this life will determine how they are treated in the hereafter (Wisker, 2020). In light of this, the role of religion in online health insurance purchases as a declaration of Islamic identity and worldview and a fulfillment of spiritual purity, the purpose is not just a packaging element for a belief system and moral code that are essential to observant Muslims' daily lives (El-Bassiouny, 2013). In the Islamic faith, commercial insurance is prohibited in all its forms, whether it is life, health, or property insurance. But it may be dealt with in two cases: The first: is that a person is forced to do so, such as if he or she is forced to insure his car, or the institution is forced to provide health insurance for its employees. The second: is that a person is forced to have health insurance or is in dire need of it because he or she is not able to receive treatment at his or her own expense without insurance. This is a need that permits dealing with health insurance according to a group of scholars because of the reason for the prohibition of this insurance (Alhazmi, 2019). Prior studies have looked at the effects of religiosity on cultural identification, purchasing behavior, and how consumers use product information as well as attitudes about materialism (Wisker, 2020;Cleveland & Chang, 2009). According to research, customers with high degrees of religiosity behave differently while making purchases than consumers with low levels of religiosity. The following hypothesis, therefore, is formulated: Hypothesis 5: Religiosity toward using the internet for purchasing online health insurance products will have a significant impact on customers' purchase intention.

Research Methodology
The research objectives of this study were attained by using a quantitative methodology to validate the research hypotheses. The study's goal is to investigate Saudi customers' present aspirations to purchase online health insurance services concerning the Saudi insurance market. This happened as a result of the study variables being quantifiable and so attainable using quantitative methods. Additionally, this study was carried out as a quantitative study to verify the key goals and assess the research hypotheses. To discover factors impacting customers' intents to take advantage of Saudi consumers' buy intentions for online health insurance services, the study used primary data, which was used for data analysis and testing of research hypotheses. To confirm study hypotheses and provide answers to research questions, primary data from a particular research population was collected using research procedures. Survey-based data collection has several benefits for researchers. First off, surveys are a cheap and effective approach to getting a lot of information from a large number of individuals (Saunders, Lewis, & Thornhill, 2009). Research studies are typically a trustworthy research technique. Because the survey is uniform, identical questions are posed to participants in the same language (Bell, Bryman, & Harley, 2022). In quantitative research, the validity and reliability of questionnaires are crucial. Measures were chosen from pertinent research that supports each configuration help to ensure the validity and reliability of the questionnaire (Goddard, & Melville, 2004). The Saudi Arabian community was the source of the study sample, which was composed of volunteers chosen at random using a straightforward random sampling technique. Despite being drawn from a variety of professions and organizations, the survey's respondents in Saudi Arabia were either internet users or those who choose to use online insurance services. was comprised. Participants were chosen at random. (1) Universities; (2) Saudi Arabian internet buying communities; A useful response was gathered from this sample. the reaction rate of the survey questionnaire was sent to participants who had already completed an informed consent form to take part in the study to gather data to test hypotheses.
In terms of measurement of variables, the attitude was measured using four items. Sampled items include "I think the use of the internet for purchasing health insurance products, would be good for me". Perceived behavioral control (PBC) was measured using four items. Sampled items include "I think that I can use the internet for purchasing health insurance products". Subjective Norms (SN) were measured using four items. Sampled items include "People who are important to me (e.g., family) would approve if I used the internet for purchasing health insurance products". Perceived Trust (PT) was measured using four items. Sampled items include "Online health insurance sites want to be known as sites who keep commitments". Religiosity was measured using nine items. Sampled items include "I enjoy spending time with others of my religious affiliation". Purchase Intention was measured using four items. Sampled items include "I intend to purchase online health insurance products in the future". Five-point Likert scale was used to measure all the items in this section. However, Both the measurement and structural models were computed in this investigation using the Partial Least Squares Structural Equation Modeling (PLS-SEM) SmartPLS 3.0 software (Ringle, Wende, & Becker, 2015). PLS is used for the following reasons: Small samples and non-normal data can be used to estimate PLS path models (Dash & Paul, 2021). The path coefficient is determined using beta values suggested by Hair, Hult, Ringle, and Sarstedt (2014).

Demographic Characteristics of the Respondents
The demographic characteristics of the respondents below show that majority of the respondents were male 236 (66.48%) while female consists of 199 (33.52%). With regards to the age of the respondents, the majority are within the 25 to 34 age brackets 199 (33.52). With regards to ethnicity, the majority of the respondents are Arabs and Asians (130)

Common Method Variance (CMV)
This study has employed Harman's One-Factor Test to find the common method bias (Podsakoff et al., 2003). However, the analysis implied not a severe issue of common method variance in this study. If the total variance for a single factor is less than 50%, it suggests that CMV does not affect the data. For the current study, the total variance was 22.931% which is less than 50% conform no CMV exists in the study data (Podsakoff et al., 2003).

Measurement Model Assessment
Before testing the proposed hypotheses, we checked the construct validity and reliability, convergent validity, and internal consistency of all the study variables. Smart-PLS 3.3.3 was engaged to check all these measures in the measurement model first then we test the hypotheses in the structural model assessment step (Hair, Hult, Ringle, & Sarstedt, 2017;Ringle, Wende, & Becker, 2020). Through the PLS algorithm procedure in Smart-PLS, we obtained the results of factor loadings of all the items which were between 0.696 to 0.867 achieved the threshold values (Hulland, 1999) and the Average Variance extracted (AVE) was higher than 0.5 achieved the recommendation of Hair et al. (2017), the Cronbach's alpha and composite reliability were higher than 0.7 that also confirmed the internal consistency Hair et al. (2017). When all the required assessments like internal consistency and convergent validity are assured (see Table 2 and Figure 2) then we check discriminant validity. The discriminant validity was confirmed through the Hetrotrait and Monotrait Ratio (HTMT). All the correlation values were less than 0.9 which achieved the recommendation of Henseler et al. (2015). Check the discriminant validity in Table 3.  A bootstrapping 5000 resampling procedure was used to examine the proposed hypotheses and all the results are presented in Table 5. In terms of the first prediction (H1), was a direct relationship between Attitude and Purchase Intention revealed to be statistically significant as the p < 0.000 which is less than 0.05, and the t-value is 4.703 which is higher than 1.96 that confirming significant effect. Similarly, the second prediction (H2) between P. B. Control and Purchase Intention also found significant as the β = 0.281, t = 6.261, p < 0.000. Since the p-value is lower than 0.05 and the t-value is higher than 1.96 that confirms a significant effect. In terms of third prediction (H3), was a direct relationship between Subjective Norms and Purchase Intention revealed to be statistically significant as the p < 0.000 which is less than 0.05, and the t-value is 3.536 which is higher than 1.96 that confirms a significant effect. Furthermore, the fourth prediction (H4) between Perceived Trust and Purchase Intention was also found significant as the β = 0.274, t = 5.720, p < 0.000. Since the p-value is lower than 0.05 and the t-value is higher than 1.96 that confirms a significant effect. However, hypothesis five (H5) was between Religiosity and Purchase Intention does not reveal statistically significant as the p-value (0.355) is higher than 0.05, and the t-value (0.927) which is lower than 1.96. Thus, all the mentioned results are presented in Table 5 and Figure 3.

Discuss
The  Vol. 14, No. 2;2022 communication strategies that emphasize how online health insurance is compatible with Islamic beliefs and dispel any doubt that online health insurance is dubious (from a religious perspective). Online health insurance can provide better deals. The findings of the present study shed important light on how online health insurance services are managed. Marketing managers can benefit greatly from the wealth of knowledge found in this study to draw in and keep potential customers. Clear indicators of consumer intentions are attitudes regarding the introduction of online health insurance. Marketing managers can address consumer sentiments and guarantee good intent in this way. According to research results, customer uncertainty can be targeted to promote favorable consumer perceptions toward online health insurance. Managers can first recognize the favorable attitudes that result in favorable purchasing intentions for online health insurance and can then build promotional materials accordingly. To accomplishes this, among other things, by increasing consumer awareness of the advantages of online health insurance. Another option is for marketers to create comprehensive marketing efforts that encourage potential customers to adopt online health insurance by not just increasing awareness but also by developing a positive attitude towards online health insurance. These campaigns may involve promotions and advertising that is specifically directed at potential customers. By bringing religious scholars and specialists in Islamic finance, television discussion shows can increase viewers' knowledge of the importance of economic and social well-being of online health insurance.

Conclusion
This paper tested the antecedents of Consumers' Purchase Intention toward Online Health Insurance in Saudi Arabia. Using Universities and Saudi Arabian internet buying communities, the paper used Smart-PLS 3 to analyze the data. The findings show that attitude, perceived behavioral control, subjective norms and perceived trust have significant positive influences on purchase intention toward online health insurance in Saudi Arabia. However, the relationship between religiosity and purchase intention toward online health insurance was not supported. The paper recommends that bringing religious scholars and specialists in Islamic finance, television discussion shows can increase viewers' knowledge of the importance of economic and social well-being of online health insurance.