Quantitative Investigation of Information Security Challenges in U.S. Healthcare Payment Ecosystems

This study quantitatively examines information security challenges in U.S. healthcare payment ecosystems and empirically links security control maturity, incident-response capability, and organizational context to measurable payment outcomes—resilience, fraud-loss exposure, and stakeholder trust. Integrating a systematic literature review (2005–2020) with a cross-sectional survey of 124 organizations (providers, payers, clearinghouses, and vendors), the research operationalized constructs such as threat exposure, vulnerability, control maturity, compliance posture, and incident-response capability using five-point Likert scales. Findings indicate that control maturity is the strongest predictor of payment resilience (β = .36, p < .001) and stakeholder trust (β = .28, p < .001), while higher maturity and response capability jointly reduce fraud-loss ratios (β = −.24, p < .001; β = −.17, p = .006). Mediation analysis confirms that incident-response capability partially offsets the detrimental effect of threat exposure on resilience (indirect α×β = −.04, 95% CI [−.08, −.01]). Moderation tests reveal that maturity’s payoff is amplified in larger and cloud-forward organizations and weakened in vendor-dense ecosystems, underscoring the role of automation and interorganizational governance. Complementary anomaly-detection pilots achieve practical precision (0.77) and recall (0.70), demonstrating the viability of analytics-based monitoring in reducing fraud losses. The integrated model explains 29–42% of outcome variance, supporting a socio-technical interpretation in which security maturity and rehearsed response routines form the foundation of resilient, low-loss, and high-trust payment operations. The study contributes validated constructs, a transparent measurement framework, and actionable pathways for CISOs, enterprise architects, and revenue-cycle leaders to strengthen payment-system security and reliability through institutionalized control maturity, incident preparedness, and vendor governance.