When capabilities backfire: Rethinking resource-based theory in health services exports

Abstract

In developing economies, the internationalization of health services remains limited despite increasing investments in firm capabilities and resources. Grounded in the Resource-Based View (RBV), this study explores the extent to which internal strengths—both tangible and intangible—contribute to the export performance of Colombian health service firms. Drawing on firm-level data from the national EDIT survey, we employed a mixed-methods quantitative approach combining Structural Equation Modeling (SEM) and a binary Logit model. SEM was used to identify latent constructs representing “Resources” and “Capabilities”, while the Logit model estimated the marginal effects of these and other predictors on the probability of export participation. Findings show that, contrary to RBV expectations, general resources and capability accumulation do not significantly enhance export propensity. Instead, internal R&D investment emerges as the only statistically significant positive predictor of exporting, suggesting that firms focused on innovation have a competitive edge in international markets. The models also reveal that a synergy between resources and capabilities—when not strategically aligned—may even hinder export engagement. These results challenge conventional interpretations of RBV in service sectors, especially in middle-income countries, and underscore the need for innovation-oriented strategies. For both managers and policymakers, the findings highlight the importance of moving beyond capacity accumulation toward targeted investment in research, talent development, and international market readiness.