Customer Identity Management in Health Insurance with Blockchain

Technology: A Literature Review

Matthias Pohl

, Hannah Giegold, Christian Haertel

, Daniel Staegemann

and Klaus Turowski

MRCC VLBA, Faculty of Computer Science, Otto von Guericke University, Magdeburg, Germany

{ﬁrstname.lastname}@ovgu.de

Keywords:

Customer Identity Management, Blockchain, Health Insurance, Access Management.

Abstract:

Customer identity management systems are an important part of the IT infrastructure of health insurance

companies. However, the current systems face challenges due to the centralized system architecture, display

disadvantages in identity veriﬁcation, and pose security risks for customer data. Since blockchain systems are

often mentioned as a solution, the goal of this paper is to examine how blockchain-based identity manage-

ment can improve this particular process of identity management in the health insurance industry. Therefore,

a systematic literature review was conducted, covering the challenges of centralized systems, a solution to the

problem through decentralized systems, and possible designs and approaches of blockchain identity manage-

ment systems. This revealed that current systems face problems in identity veriﬁcation, authentication, user

experience, data storage, data security, and data control. In addition to that, it was found that decentralized

systems can solve many of those challenges. They facilitate the know-your-customer process for customers

and companies, increase data security, create a trusting relationship between the customer and the company,

and give customers control over their data. Thus, the use of a decentralized identity management system for

the insurance industry is associated with advantages and has great potential to improve the current identity

management process.

1 INTRODUCTION

As digitization progresses, our technology continues

to evolve and ensures that our everyday lives are in-

creasingly being shaped by the use of digital services

and processes, as shown by the Global Digital Sen-

timent Survey 2022 by McKinsey & Company, in

which 70% of respondents used these services (McK-

insey & Company, 2022). Due to ﬁerce competition,

companies are under pressure to offer their customers

an excellent user experience (UX) to retain them in

the long term and attract new customers. In addi-

tion to the ease of use of the systems, providers must

ensure that the stored customer data is securely pro-

tected and offer suitable customer identiﬁcation and

authentication. The latter is of central importance,

since according to the Global Identity & Fraud Re-

port, identity theft is one of the greatest risks within

the virtual world (Experian Information Solutions,

https://orcid.org/0000-0002-6241-7675

https://orcid.org/0009-0001-4904-5643

https://orcid.org/0000-0001-9957-1003

https://orcid.org/0000-0002-4388-8914

2022). According to the Modern Bank Heist 3.0,

the Banking, Financial Services and Insurance (BFSI)

sector is one of the most popular targets for cyber-

criminals and in 2020 80% of respondents reported an

increase in attacks compared to previous year (Keller-

mann and Murphy, 2020). The reason for this is the

large amount of valuable data, which includes the per-

sonal and ﬁnancial information of customers (Euro-

pean Insurance and Occupational Pensions Author-

ity, 2021). As a result, companies in the insurance

environment need to ensure proper customer identity

and access management (CIAM) to meet the grow-

ing challenges. However, currently deployed sys-

tems face problems such as vulnerabilities in authen-

tication and veriﬁcation methods, obstacles due to

centralized system architectures, high risk of cyber-

attacks, and drawbacks for UX (Mulaji et al., 2021).

Due to these challenges, it is signiﬁcant to investigate

new alternatives. In this regard, blockchain technol-

ogy has the potential to transform identity manage-

ment processes in the insurance industry. The use of

this technology is not yet widespread in the sector, but

its use offers the opportunity to reduce costs, increase

process efﬁciency, facilitate new customer veriﬁca-

Pohl, M., Giegold, H., Haertel, C., Staegemann, D. and Turowski, K.

Customer Identity Management in Health Insurance with Blockchain Technology: A Literature Review.

DOI: 10.5220/0012575200003657

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2024) - Volume 2, pages 803-811

ISBN: 978-989-758-688-0; ISSN: 2184-4305

803

tion, and increase trust and transparency among the

parties involved. In addition, the use of blockchain

facilitate the detection and prevention insurance fraud

(European Insurance and Occupational Pensions Au-

thority., 2021).

Several studies have examined the role of

blockchain in identity management and insurance.

One study highlights how blockchain and other digital

technologies can revolutionize the insurance industry,

emphasizing their potential for customer-centric ser-

vices and cost reduction, but also noting challenges

in replacing legacy systems (Eckert and Osterrieder,

2020). Another study uses a SWOT analysis to assess

beneﬁts and drawbacks of blockchain in insurance,

suggesting its potential to streamline processes yet ac-

knowledging the need for further development (Gat-

teschi et al., 2018). Research in the BFSI sector fo-

cuses on the signiﬁcance and transformative impact of

blockchain in identity management, particularly high-

lighting the promise of the Zero-Knowledge-Proof

technology (ZKP) (Akram and Sen, 2022). A com-

prehensive literature review and various investiga-

tions into blockchain-based identity management sys-

tems reveal their potential to overcome traditional

system limitations but indicate that blockchain tech-

nology still lags in implementation and efﬁcacy com-

pared to existing solutions (Ahmed et al., 2022, Ku-

perberg, 2020). Lastly, a study on the practicality

of blockchain for organizational identity management

suggests it holds promise but is still in a developmen-

tal phase, with proper planning needed for effective

implementation (Mulaji et al., 2021). Compared to

existing studies, the paper at hand focuses on iden-

tity management and veriﬁcation in the insurance en-

vironment. In order to clarify the objectives of future

research, the following research question (RQ) will be

answered:

RQ: How does the current research landscape of

academic and commercial Blockchain solutions for

identity management look like?

To answer the research question, this introduction

to the research topic is followed by a detailed expla-

nation of the research methodology, focusing on the

structured literature review process. The results sec-

tion (Sec. 3) presents a comprehensive overview of

academic and commercial solutions identiﬁed in the

literature review. Finally, the paper offers a compar-

ative analysis of these solutions from technical and

process perspectives, culminating in a conclusion that

summarizes key ﬁndings and suggests directions for

future research.

2 METHODOLOGY

This section describes the procedure of the systematic

literature search. It includes the selected databases,

search terms, the inclusion and exclusion criteria, as

well as a presentation of the search results and the

search process. In general, we follow the approach of

vom Brocke et al. Brocke et al. (2009). After deﬁn-

ing the review scope (I) in section 1, we conceptu-

alize the topic (II) of the literature review in subsec-

tion 2.1.Subsequently, the search process (III) can be

started, which is described in subsection 2.3. The re-

sults are compiled and analyzed in sections 3 and 4

(IV). Finally, the summary of results provides an out-

look on the research agenda (V).

The search process is conducted on the scientiﬁc

literature databases of ACM, IEEE, Scopus, Springer

Link, and Web of Science. These databases were cho-

sen for searching as they cover an extensive collection

of literature in the necessary subject areas.

2.1 Search Terms

For the systematic literature review, search terms

were formed, which were composed of different

topic-related terms. The terms were derived based on

the title, objective, and research question and divided

into the four components ”blockchain”, ”customers”,

”identity management”, and ”insurance”. The forma-

tion was done with the help of the Boolean operators

”AND” between the components to limit the search

results and ”OR” between the basic terms to consider

synonyms during a search. Furthermore, parts of the

expressions of the identity check were combined with

terms from the component ”customers” to reduce the

results of the search and to specify the generic terms.

In addition, the wildcard operator (*) was used to in-

clude variations of the individual terms in the search.

The search terms are constructed with the following

concepts:

• Blockchain: blockchain, blockchain-technology,

blockchain-based, distributed ledger, DLT

• Customers: customer, user

• Identity Management: identity, identiﬁcation,

identity veriﬁcation, identity authentication, iden-

tity management, access management, CIAM,

self-sovereign identity, SSI, decentralized iden-

tity, KYC

• Insurance: insurance, BFSI

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2.2 Inclusion and Exclusion Criteria

For the systematic literature search, inclusion and ex-

clusion criteria were determined to assess the litera-

ture found in terms of its suitability and relevance.

The search was limited to publications in English and

German. In addition, only conference papers and

journal articles were considered due to being peer-

reviewed. In addition, exclusion will occur if the pro-

posed IDM solution is not a blockchain-based system.

Further, papers will be excluded that do not focus on

or consider IDM systems and papers that especially

focus on the legal topic of the systems. Additionally,

entries will not be considered if their environment and

the IDM are not in the enterprise, BFSI, general sys-

tems, cloud, Internet of Things, customer, or public

sectors.

2.3 Literature Search Results

During the systematic literature search, a total of

2,090 hits were obtained using the databases by ap-

plying the search restrictions (Sec. 2.1). After dupli-

cates were removed, 1,545 entries remained. Subse-

quently, the title and abstract were evaluated for rel-

evance with the addition of the inclusion and exclu-

sion criteria of the topic and setting. Thus, the total

number was reduced to 370 entries. In addition to

this, a further 15 entries were removed because of un-

availability of the full text. After the pre-selection,

the remaining entries were subjected to a full-text re-

view. The elimination was based on the criteria of

language, availability, environment, and subject mat-

ter. Four papers were eliminated because the full text

was only available in Chinese. 20 other papers were

sorted out because they had a supply chain (4), en-

ergy sector (5), smart city (4), or other (7) environ-

ment. Thematically, a total of 248 entries were re-

moved. 147 articles were sorted out because they had

an inappropriate subject focus. Instead of an IDM

system, the focus was on speciﬁc advances (e.g., data

storage, data sharing, contact tracking), technologies

(e.g., blockchain, Inter Planetary File System, ZKP),

or ﬁnancial applications and payment systems. 91 pa-

pers were eliminated because the proprietary solution

presented was not a blockchain-based IDM system,

and seven publications were excluded because they

had a strong focus on blockchain or the legal frame-

work of the systems. After the review, 83 submissions

remained. These were divided into the groups ”own

blockchain IDM solution” (50 entries) and ”other lit-

erature” (33 entries). Group one was used for the

selection of blockchain-based systems in Section 3.

For the second group, an additional look was taken

to see, which papers dealt with a tabular comparison

of blockchain-based IDM solutions. The comparison

criteria for Section 4 were derived from the remain-

ing 14 papers. Companies within this industry and

their IDM systems were investigated independently.

In addition, studies and articles from insurance trade

magazines were included. To provide a comprehen-

sive analysis of blockchain IDM systems, commer-

cial solutions were examined to amend the scientiﬁc

literature research. This analysis was based on pub-

lished white papers, documentations, and entries on

company websites.

Search Results

(n = 2096)

After Removing Duplicates

(n = 1545)

After Analysis of Titles and Abstracts

(n = 355)

Included Studies

(n = 83)

Studies on blockchain-based

solutions (n = 50)

Studies for framework analysis

(n = 33)

Figure 1: Overview of literature selection process.

3 BLOCKCHAIN IDENTITY

MANAGEMENT SOLUTIONS

In the following, various blockchain identity manage-

ment solutions are examined. The ﬁrst subsection

gives an insight into proposed approaches from the

scientiﬁc literature and the second section delves into

commercial solutions.

3.1 Academic Solutions

From the literature review, 50 proposals emerged,

which were reviewed using an additional selection

process, thus reduced to eight solutions. This process

centered on determining if the proposal addresses a

general identity management system or speciﬁc in-

dividual processes. Emphasis is placed on identify-

ing publications that propose self-sovereign identity

(SSI) systems, with a focus on papers that adhere to

SSI principles and describe identity management or

Know Your Customer (KYC) processes. To ensure

relevance, papers lacking citations or use cases in gen-

eral identity management, BFSI, or cloud computing

are excluded from further analysis (see Table 1).

Customer Identity Management in Health Insurance with Blockchain Technology: A Literature Review

805

Table 1: Overview on solutions from academic literature.

Ref BP BT C I S

Soltani et al. (2021) Hyperledger Indy public, permissioned Plenum n off

Chen et al. (2021) Hyperledger Fabric consortium Kafka-Consensus y off

Liao et al. (2022) Ethereum consortium Proof-of-Authority y off

Bandara et al. (2022) Rahasak permissioned Kafka-Consensus y off

Otta and Panda (2022) Ethereum - Proof-of- Work y off

Schlatt et al. (2022) - - - n off

Abraham et al. (2021) - permissioned - y off

Hong and Kim (2020) Ethereum - - y on

3.2 Commercial Solutions

The following section contains the analysis of ex-

isting blockchain-based IDM solutions. Based on

the “KuppingerCole Market Compass Decentralized

Identity: Blockchain ID & SSI Solutions” (Bailey,

2020), the solutions mentioned therein were consid-

ered. In a further selection process, the solutions

were reduced to ﬁve products, as the solutions elim-

inated did not have sufﬁcient documentation or were

in the development or test phase at the time of the

review. Exclusion due to a lack of documentation

relates to the KYC systems Authenteq and Know-

MeNow. The identity solution ShoCard was taken

over by Ping Identity and integrated into their prod-

uct PingOne Neo (Bailey, 2020), whiich is currently

in its test phase. The two uPort products Serto Iden-

tity and Veramo as well as the Cambridge Blockchain

are only in beta status or development and are elimi-

nated for closer examination. Thus, only ﬁve selected

solutions are considered for comparison (see Table 2).

4 SELF-SOVEREIGN IDENTITY

MANAGEMENT SYSTEMS

The following section examines the extent to which

self-sovereign identity management systems can have

the potential for improving identity management.

4.1 General Perspective

Decentralized identity management systems provide

a secure and trusted method for identity veriﬁcation

and management (Akram and Sen, 2022). They are

considered as problem solvers of centralized systems

(Panait et al., 2020). With their advantageous sys-

tem architecture, they ensure that personal customer

data is no longer stored centrally at an instance, but

decentrally at the users themselves. The elimination

of the central authority shifts the balance of power

in favor of the customer and balances the previously

asymmetrical trust relationship (Panait et al., 2020).

When using digital services, the user can decide in-

dependently, which data should be shared with the

service provider (Nuggets Ltd, 2017) and disclosure

of the customer’s personal data is only possible with

their consent. In addition, the independence from

central organizations ensures that the existence and

functionality of users’ digital identities are not depen-

dent on them (SelfKEy DAO, 2023). The user can

select partial information from their Veriﬁable Cre-

dentials (VC), which ensures that the organization

only receives the data it needs to verify the user. Us-

ing cryptographic techniques such as ZKP and data

minimization, the user data privacy can also be in-

creased and legal regulations such as the GDPR are

easier to comply with (SelfKEy DAO, 2023). In-

creased data security is also the result of having cen-

tralized data servers, which mitigates the risk from

data leaks (Mulaji et al., 2021). If fraudsters want

to steal an identity of a user, they must be in pos-

session of their cryptographic key pair to prove that

they are the owner of the stolen VC (Dock Labs AG,

2023). However, since the customer data and pri-

vate keys are usually stored in their own SSI wallets,

they must have malicious actors to penetrate each user

wallet. Consequently, the chance of identity theft is

reduced (Panait et al., 2020). Another advantage is

the increased resilience to a Single-Point-of-Failure

(SPOF) compared to the centralized systems due to

disintermediation and decentralization (Mulaji et al.,

2021). Common standards and protocols such as De-

centralized Identiﬁers (DID) provide interoperability

among SSI-systems and an improved UX. They al-

low data to be transferred efﬁciently and more eas-

ily between systems without compromising user se-

curity, control rights, and privacy (SelfKey Founda-

tion, 2017). Moreover, they allow the user to use

the same digital identity for different applications or

services. Thus, the management of digital identities

becomes easier (SelfKey Foundation, 2023). The in-

secure password login method of centralized systems

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Table 2: Overview on commercial solutions.

Name BP BT C Year Costs S OS

BlockID Ethereum private, permissioned Proof-of-Authority 2018 y on n

Civic Solana public Proof-of-Stake, Proof-of-History 2015 y off n

Evernym Sovrin public, permissioned Plenum 2013 y/n off y

Nuggets Ethereum public - 2017 y off n

SelfKey Ethereum public Proof-of-Authority 2017 n off y

is replaced by a passwordless method, the decentral

identiﬁer, in the SSI-IDM. Moreover, cryptographic

veriﬁcation mechanisms of DID increase the security

of user authentication compared to passwords (Self-

KEy DAO, 2023). Through digital signatures, users

can prove the integrity and authenticity of the trans-

mitted data and be veriﬁed as the unique owner of

the digital identity (Dock Labs AG, 2023). Further,

the use of the trusted certiﬁcates and SSI solution en-

sures that insurance fraud can be better detected or

even prevented (Eckert and Osterrieder, 2020). Be-

sides the above point, the use of cryptography and

VC supports fast and easy veriﬁcation of new cus-

tomers and guarantees the validity and integrity. The

SSI system can speed up the process because the veri-

ﬁer can check the data of customers in real-time with-

out contacting the issuer of the information. In ﬁ-

nance, this can reduce the onboarding process for new

customers from an average of one to three months

to a few days or hours (SelfKEy DAO, 2023). The

use of digital signatures enhances security by allow-

ing precise veriﬁcation of the issuer of the data and

the intended recipient, thereby making it more chal-

lenging to manipulate, steal, or create false identity

data (Dock Labs AG, 2023). In addition, the use of

blockchain as a trusted data registry ensures that the

stored data is difﬁcult to change or manipulate (Mu-

laji et al., 2021) and the origin of incorrect data can

be determined (Nuggets Ltd, 2017). The SSI system

reduces the number of KYC processes for new cus-

tomers to one veriﬁcation, as companies can share

customer data from the decentralized ledger across

corporate domains (Akram and Sen, 2022, Eckert and

Osterrieder, 2020, Nuggets Ltd, 2017). The user can

use the VC received with other companies that also

require a KYC check (Dock Labs AG, 2023). In addi-

tion to saving time, shared customer veriﬁcation saves

companies ﬁnancial budgets (Nuggets Ltd, 2017). A

further reduction in expenses results from the fact

that companies no longer need to store, protect, and

manage sensitive data of users and passwords (Mu-

laji et al., 2021). In addition, customer SSI self-

management ensures a reduction in customer service

expenses as data can be changed and updated syn-

chronously across all services (Dock Labs AG, 2023,

SelfKEy DAO, 2023). The use of a decentralized

management system can improve the relationship be-

tween a company and its customers and help build a

two-way trust through mutual authentication. By us-

ing SSI agents as intermediaries between the two par-

ties, both agents can share VCs with each other and

verify that they are valid. If one party’s VC proves

to be invalid, the agents can inform their owners and

terminate the connection to protect users from phish-

ing sites (SelfKEy DAO, 2023). In summary, the use

of an SSI system provides clients with more conve-

nience, security, and privacy than a centralized IDM

(SelfKEy DAO, 2023).

4.2 Potentials of Blockchain Identity

Management Solutions

The analysis of the 13 solutions shows that the use

of a blockchain-based identity management in the in-

surance environment can solve challenges of central-

ized systems and realize the majority, of the elabo-

rated advantages. The evaluation criteria include as-

pects like decentralized data storage, user-centric data

sovereignty, independence from central authorities,

the application of cryptographic security measures,

and the management of private keys by users them-

selves. In addition, we checked on an increased resis-

tance to a SPOF, a portable identity, a reusable KYC-

VC as well as a passwordless login, and whether the

ﬁrst identity check is performed with VC (see Table

3). The results of the analysis show that all but one of

the systems allow decentralized storage of user iden-

tity data and ensure that no single entity or central sys-

tem has complete control over customer data. In all of

the solutions examined, the user bears responsibility

for their data, can access it via their wallet, and can

easily manage or change it. In addition, all solutions

conﬁrm the advantage that data sharing is only possi-

ble with the explicit consent of the customer and can

be done selectively. The analysis also shows that the

use of SSI systems provides an increased resistance to

SPOF. This is ensured by the decentralized structure

of the blockchain used in all systems, which stores

information regarding identity distributed across mul-

tiple nodes and enables secure data exchange across

enterprise domains. The increased resilience is sup-

ported by the use of decentralized login procedures

Customer Identity Management in Health Insurance with Blockchain Technology: A Literature Review

807

Table 3: Comparison of SSI solutions with an analysis framework adapted from scientiﬁc literature.

Name DS SM DT U SD DID VC SP LS ZKP S W AS PI PL IP1 KYC1 DU

KYC2 Y Y Y N Y Y Y Y - Y Y Y Y Y - N Y N

SSI-Chain Y Y Y N Y Y Y Y - Y Y Y Y Y Y Y - N

BIMAC N Y Y N Y Y - Y - - Y Y Y Y Y - Y P

Casper Y Y Y N Y Y - Y - Y Y Y Y Y N N Y N

Otta et al. Y Y Y Y Y Y Y Y - - Y Y Y Y Y Y - N

Schlatt et al. Y Y Y P Y Y Y Y Y Y Y Y Y Y Y P Y P

Abraham et al. Y Y Y N Y Y Y Y - Y Y Y Y Y Y Y - N

Vault-Point Y Y Y Y Y - - Y - - Y P Y Y Y N - N

BlockID Y Y Y N Y Y Y Y - - Y Y Y Y Y N Y N

Civic Y Y Y P Y Y Y Y - - Y P Y Y Y N Y N

Evernym Y Y Y N Y Y Y Y - Y Y Y Y Y Y P Y N

Nuggets Y Y Y P Y Y Y Y - Y Y Y Y Y Y N Y N

SelfKey Y Y Y N Y Y Y Y - Y Y Y Y Y Y N Y N

DS: decentralized data storage, SM: self-management, DT: data sharing through user consent, U: independence from central instance, SD: selective data

forwarding, DID: decentralized identiﬁer, VC: veriﬁable credentials, SP: key pair, LS: link secret, ZKP: zero-knowledge proof, S: private key on customer

device, W: Resistance to SPOF, AS: use of general standards, PI: portable identity, PL: passwordless login, IP1: initial identity check with veriﬁable

credentials, KYC1: one-off KYC check, DU: storage of all sensitive customer data at the company (Y: Yes, N: No, P: Partly)

and general standards. Additionally, the interoper-

ability among solutions reduces the risk of being de-

pendent on a particular system. However, complete

exclusion of a SPOF does not occur as the VaultPoint

and Civic solutions demonstrate. Each system allows

the customer to have a portable identity and eleven of

the analysed systems use a passwordless login. The

decentralized login used by the majority, using DIDs

or the cell phone as an authentication device, conﬁrms

the replacement of the traditional username/password

method. Protected by cryptographic measures, it

leads to more security, convenience, and an improved

UX. Some of the anaylzed solutions show that this can

be increased by simply updating all accounts via the

wallet and automatically ﬁlling out forms. In addi-

tion, individual systems offer users to monetize their

own data and deposit them with a real value. Another

beneﬁt reinforced by the research are the time and

cost savings for identity veriﬁcation processes that

are possible with the use of SSI systems. The ma-

jority of solutions allow the customer to go through

the full KYC veriﬁcation process only once. They

can use the issued VC or token to identify themself

at other service providers. In addition to cost savings

in the KYC process, the analysis shows a reduction in

spending due to the elimination of securing sensitive

data on company servers. A deviation only occurs in

two of the examined solutions, where storage in case

of suspicion or central storage of customer data on

bank servers is mentioned. All solutions use crypto-

graphic measures. They reduce the dangers of identity

veriﬁcation through VCs and DIDs and provide more

security and privacy to the user through the use of

ZKPs, link secrets, and cryptographic key pairs. Sce-

nario analyses of the solutions also show that the SSI

systems provide increased security against data theft

as this is more costly compared to central databases.

Private keys of customers are stored on private de-

vices in all system architectures. The blockchain as a

trustworthy data registry and reputation system acts as

a bilateral communication channels, with mutual au-

thentication, zero trust, VC as well as tokens, thus the

trust is increased between the different parties. How-

ever, a complete independence from central instances

and improvements for identity veriﬁcation cannot be

fully realized. The ﬁrst point is inﬂuenced in the sys-

tems by the architecture of the blockchain, the used

consensus mechanism, or the initial identity veriﬁca-

tion. Seven solutions use permissions, consortium, or

private blockchain, which provide clients with greater

independence than centralized systems, but network

access and participant rights are still controlled by one

or more central entities and are thus not fully decen-

tralized. Moreover, consensus mechanisms such as

proof-of-authority ensure that users are dependent on

a central authority and must trust the validators (Mal-

hotra et al., 2022). Beneﬁts from using VC for ini-

tial veriﬁcation cannot be realized in seven cases. In

these solutions, the initial identity veriﬁcation in the

SSI ecosystem takes place without VC and relies on

the procedures already used in the centralized solu-

tions. In the study, only three of the identity manage-

ment solutions examined use VC for initial veriﬁca-

tion, while two others offer both VC and alternative

methods. However, the identity veriﬁcation process

in seven of the systems is vulnerable to tampered ev-

idence as they depend on trusted entities for the veri-

ﬁcation and issuance of VC. Regarding the introduc-

tion of these systems, high security requirements for

digital wallets (Bach, 2021) and the need for special-

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ized terminals to store cryptographic keys are further

challenges. A lack of awareness and lack of or in-

correct knowledge of people about the new technol-

ogy can lead to difﬁculties in adopting it (SelfKey

Foundation, 2023). In addition, the UX may suffer

if system operations are too complex or new to users.

The user trades control for convenience (Preukschat

and Reed, 2021) and faces extra work as they are re-

sponsible for managing, backing up, and protecting

their own data (SelfKey Foundation, 2023). There

is also a risk of consent fatigue if the customer has

to manage too many requests (Soltani et al., 2021).

Insurance companies face the problem of integrating

the new systems into their existing IT infrastructure.

Although the majority of the analyzed market solu-

tions are white-labeled products that are easy to inte-

grate with the help of documentation, the IT depart-

ment of the insurer still needs the technical know-how

and skills to understand and develop the code (Eckert

and Osterrieder, 2020). In addition, the redesign of

the IT landscape might necessitate large investments

(SelfKey Foundation, 2023). Further, for the utiliza-

tion of blockchain-based systems, both customers and

companies must obtain the appropriate currency to fa-

cilitate payment for transactions and services (1Kos-

mos Inc., 2023). The adoption of blockchain technol-

ogy and decentralized storage in systems faces several

challenges. Scalability issues and limitations in stor-

age space are signiﬁcant concerns (SelfKey Founda-

tion, 2023). The choice of consensus mechanism can

affect system performance, resource usage, and may

result in less decentralization. Data storage methods

also present difﬁculties as on-chain storage hampers

scalability and system speed, and raises issues regard-

ing the right to be forgotten, as personal data could

remain permanently on the ledger. Off-chain storage,

on the other hand, is susceptible to corruption and

tampering (Nuggets Ltd, 2017). Additionally, user

access to data is dependent on private keys. Losing

these keys poses a risk, although recovery solutions

like BIP39 exist, they are not foolproof, and losing

recovery phrases means losing access to private data

(Soltani et al., 2021). Furthermore, authentication

with Decentralized Identiﬁers (DIDs) has been found

to be more time-consuming than traditional password

methods. Finally, uncertainties and lack of guide-

lines in the legal and regulatory environment compli-

cate the diffusion of systems in the insurance sector

and the veriﬁcation of documents (Eckert and Oster-

rieder, 2020). Despite these challenges, the use of SSI

systems offers many beneﬁts to the insurance indus-

try and its customers and can overcome the majority

of the challenges of centralized IDM systems. How-

ever, two issues cannot yet be fully answered and, in

conjunction with SSI systems’ native challenges, con-

tinuous development of the technology is needed to

solve these problems.

5 CONCLUSION

This research explored how blockchain could enhance

customer identity management in the insurance indus-

try. It highlights that current systems are centralized,

posing risks like data breaches and limited user con-

trol. The study suggests that blockchain-based SSI

systems could offer improvements by decentralizing

data management and enhancing security and user au-

tonomy. However, SSI systems also have limitations,

such as partial decentralization and similar vulnera-

bilities in identity veriﬁcation. Future work should

include an in-depth security evaluation of blockchain-

based self-sovereign identity systems. This would in-

volve assessing their resilience to cyber threats, data

integrity, and privacy safeguards. Analyzing how

these systems conform to established security princi-

ples would be crucial (Allen, 2016). Expanding the

research to include insurance companies on a global

scale, particularly in Europe and other regions, would

provide a more comprehensive understanding of iden-

tity management practices. This broader perspec-

tive could highlight regional differences and similar-

ities, offering a more nuanced view of the challenges

and opportunities in adopting blockchain technology

for identity management. Investigating a variety of

other SSI and Decentralized Trust Infrastructure sys-

tems could enrich the understanding of the landscape.

This exploration should aim to assess different mod-

els and architectures, comparing their effectiveness,

user-friendliness, and scalability. The study should

expand its criteria catalog to encompass emerging at-

tributes and technologies. This would involve ex-

ploring new blockchain features, advancements in en-

cryption, and evolving regulatory requirements. Such

an extension would ensure that the analysis remains

relevant and comprehensive in the rapidly evolving

ﬁeld of digital identity management. A further criti-

cal area for future research is the practical implemen-

tation of SSI systems in the insurance industry. This

includes pilot studies or case studies demonstrating

real-world applications and challenges. Investigating

the gap between theoretical beneﬁts and actual out-

comes in these implementations would provide valu-

able insights into the feasibility and effectiveness of

SSI systems in a real-world setting. Besides, the de-

velopment of a further fully comprehensive approach

to SSI-IDM using blockchain technology (Pohl et al.,

2020) and the modeling of integration into organiza-

Customer Identity Management in Health Insurance with Blockchain Technology: A Literature Review

809

tional processes (Pohl et al., 2023) can be pursued.

Finally, understanding the factors that inﬂuence user

acceptance and adoption of these systems is essential.

Future studies should explore the societal, behavioral,

and technological barriers to the widespread adoption

of blockchain-based identity management solutions.

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