Through a multiple case study of six digital startups in the healthcare ecosystem, we develop a framework of entry through innovation in a regulated ecosystem. The framework reveals the interplay of two dimensions that have not been examined in conjunction so far: 1) the degree of ecosystem disruption brought by the entrant's innovation; 2) the impact of regulation/policy on the entrant's innovation. Based on these two dimensions, our data reveal four scenarios for entrants: dual constraint; regulatory-enabled orchestration; regulatory-constrained complementation; and dual enablement. The paper provides several contributions to ecosystem research, including a new definition of ecosystem disruption, the joint consideration of two key dimensions of ecosystem entry, and an emergent framework illustrating specific strategies, governance mechanisms, and the likelihood of success for each entry scenario. We show that start-up entrants can be successful orchestrators if they are enabled by regulation, that they can shift their positioning to seize enabling regulations, and that being an orchestrator or a complementor is a strategic choice related to an entrant's ecosystem disruption strategy.

通过对医疗保健生态系统中六家数字初创公司的多个案例研究，我们开发了一个通过创新进入受监管生态系统的框架。该框架揭示了迄今为止尚未结合研究的两个维度的相互作用：1）进入者的创新所带来的生态系统破坏程度；2）监管/政策对进入者创新的影响。基于这两个维度，我们的数据为进入者揭示了四种场景：双重约束；监管支持的编排；监管限制的互补；和双重赋能。该论文对生态系统研究做出了多项贡献，包括生态系统破坏的新定义、对生态系统进入的两个关键维度的共同考虑，以及说明具体策略、治理机制和每个进入场景的成功可能性的新兴框架。我们表明，如果受到监管的支持，初创企业进入者可以成为成功的协调者，他们可以改变自己的定位以抓住有利的监管，并且成为协调者或补充者是与进入者的生态系统破坏战略相关的战略选择。