Outsidership vs insidership – internationalization of health-care SMEs

Abstract

Purpose

The paper aims to explore how small- and medium-sized enterprises (SMEs) in the health-care sector overcome the liability of being an outsider, instead of gaining a position as an insider in new networks in markets abroad and subsequently internationalizing. The following research questions are posed: How do firms in complex health-care markets build network relationships? How is business market knowledge developed and legitimacy acquired to overcome the liability of outsidership?

Design/methodology/approach

The paper uses a multiple-case methodology in a nested case study of health-care SMEs, which allows for in-depth study of the importance of network relationships, business market knowledge development and legitimacy building to enter a target market; the study maps the activities and different actor roles as the entry process unfolds. The study draws on empirical evidence from 13 companies as well as industry and interest organizations.

Findings

The results provide support for process-based explanations of how, but also of why the internationalization of health-care SMEs takes place in distinctive sequential phases, where it is necessary to complete one phase before it is possible to embark on the next. The study answers the calls for more empirical studies capturing how firms actively enter networks to overcome the liability of outsidership, become insiders and subsequently internationalize.

Originality/value

The principal contribution of the authors’ study is to add to the body of research on internationalization and advance the understanding of how to build an insidership position in relevant networks by overcoming the liability of outsidership. By choosing to study firms in the health-care sector, the authors also contribute to the limited research on firms entering markets characterized by a high level of complexity.

Citation

Lagerström, K. and Lindholm, C. (2021), "Outsidership vs insidership – internationalization of health-care SMEs", Journal of Business & Industrial Marketing, Vol. 36 No. 11, pp. 2025-2036. https://doi.org/10.1108/JBIM-05-2019-0250