Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships

Rinenggo, Aswindaru; Sudiro, Achmad; Sunaryo; Hussein, Ananda Sabil Article Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships Cogent Business & Management Provided in Cooperation with: Taylor & Francis Group Suggested Citation: Rinenggo, Aswindaru; Sudiro, Achmad; Sunaryo; Hussein, Ananda Sabil (2024) : Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships, Cogent Business & Management, ISSN 2331-1975, Taylor & Francis, Abingdon, Vol. 11, Iss. 1, pp. 1-14, https://doi.org/10.1080/23311975.2024.2371991 This Version is available at: https://hdl.handle.net/10419/326392 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ Cogent Business & Management ISSN: 2331-1975 (Online) Journal homepage: www.tandfonline.com/journals/oabm20 Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships Aswindaru Rinenggo, Achmad Sudiro, Sunaryo & Ananda Sabil Hussein To cite this article: Aswindaru Rinenggo, Achmad Sudiro, Sunaryo & Ananda Sabil Hussein (2024) Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships, Cogent Business & Management, 11:1, 2371991, DOI: 10.1080/23311975.2024.2371991 To link to this article: https://doi.org/10.1080/23311975.2024.2371991 © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group View supplementary material Published online: 04 Jul 2024. Submit your article to this journal Article views: 1257 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=oabm20 Marketing | research article Cogent Business & ManageMent 2024, VoL. 11, no. 1, 2371991 Trustworthiness in Indonesia healthcare: fostering loyalty in B2B relationships aswindaru rinenggo , achmad sudiro , sunaryo and ananda sabil hussein Department of Management, Faculty of economics and Business, universitas Brawijaya, Malang, indonesia ABSTRACT the expansion of healthcare infrastructure has led to a surge in demand for diagnostic equipment, presenting opportunities for healthcare equipment suppliers. however, the market faces challenges, including intense competition exacerbated by limited product differentiation and a surplus of suppliers. amidst this competitive landscape, understanding the factors influencing business consumer preferences and loyalty becomes crucial for suppliers. theoretical perspectives highlight trust as a foundational element in business-to-business (B2B) relationships, influencing loyalty. Perceived value, reflecting consumer assessments of product quality, pricing, and relational benefits, mediates this relationship. nevertheless, research on trust and loyalty in B2B healthcare markets, particularly in indonesia, remains limited. Furthermore, the role of switching costs in shaping loyalty, especially in the context of healthcare equipment, is underexplored. employing structural equation Modeling-Partial least squares (seM-Pls), this study investigates trust, perceived value, switching costs, and loyalty dynamics between private hospitals and equipment providers in Java, indonesia. Findings reveal that trust significantly influences loyalty, with perceived value partially mediating the trust-loyalty relationship. surprisingly, switching costs do not moderate the trust-loyalty relationship. this study’s contributions include clarifying trust and loyalty dynamics in B2B healthcare markets in indonesia and underscoring the importance of perceived value in driving loyalty. Despite limitations, such as geographic scope, this research informs strategic marketing and relationship management in the healthcare equipment sector. Introduction Developing long-lasting relationships with customers is considered crucial, as losing customers is costly, especially in the business to business (B2B) market (raimondo etal., 2008). One main theoretical concept shaping loyalty is relationship quality, particularly stemming from trust, as proposed by Berry (1983). trust has been widely discussed as one of the crucial factors for fostering loyalty of the customer. researchers such as hennig-thurau et al. (2004), Bojei and aryaty, (2010), Bataineh et al. (2015) have suggested that good relationship quality reflects successful relationship activities, characterized by a reciprocal exchange of costs and benefits inherent in business transactions, aligning with the principles of social exchange theory (cook & rice, 2020; homans, 1958). this exchange of costs and benefits shapes perceived value, as B2B consumers perceive the value and benefits received from various aspects related to supplier support and commitment (Yuan et al., 2020). researchers typically define perceived value as the mediating factor in the relationship between trust and loyalty, as consumers’ trust in product information, quality, and service can significantly influence perceived value, thereby fostering loyalty effectively (aw etal., 2019; Yuan et al., 2020; Zauner et al., 2015). © 2024 the author(s). Published by informa uK Limited, trading as taylor & Francis group CONTACT aswindaru Rinenggo [email protected].ac.id Department of Management, Faculty of economics and Business, universitas Brawijaya, Malang 65145, indonesia. supplemental data for this article can be accessed online at https://doi.org/10.1080/23311975.2024.2371991. https://doi.org/10.1080/23311975.2024.2371991 this is an open access article distributed under the terms of the Creative Commons attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. the terms on which this article has been published allow the posting of the accepted Manuscript in a repository by the author(s) or with their consent. ARTICLE HISTORY received 22 February 2024 revised 16 May 2024 accepted 18 June 2024 KEYWORDS trust; loyalty; B2B; healthcare; switching cost; perceived value REVIEWING EDITOR Osikhuemhe Okwilagwe, Bournemouth University Faculty of Management: Bournemouth University Business school, United kingdom of great Britain and northern ireland SUBJECTS Business, Management and accounting; industry & industrial studies; economics; Marketing 2 a. rinenggO etal. While literature indicates that trust serves as a psychological foundation in the market transaction, a topic somewhat underexplored in the motivation of customer behavior in B2B market (cherry, 2015). Furthermore, inconsistencies persist in the relationship between trust and loyalty. While recent studies demonstrate a significant positive correlation between trust and loyalty (see Biedenbach et al., 2019; cabanelas et al., 2024; cui et al., 2023; Zhao et al., 2019), both directly and indirectly, others reveal a non-significant relationship, contradicting relationship quality theory (see hong & cho, 2011; kaur & soch, 2018). in addition, although many studies typically adopt relationship quality theory to build and maintain customer loyalty, recent studies identify one factor that may influence the effectiveness of these strategies; switching costs (el-Manstrly, 2016; iqbal et al., 2023). customers incur costs when they reinvest time to switch to different product and service providers—time spent, effort exerted, energy, and knowledge acquired, all of which may affect customer loyalty to a particular supplier (hess & enric ricart, 2003; russo et al., 2016). Mittal (2016) suggests that customers tend to remain loyal to a supplier when switching to a competitor is perceived as too costly, as supported by D.t. nguyen et al. (2020). however, the influence of switching costs on customer loyalty varies based on market characteristics. While B2B buyers generally exhibit low switching costs and minimal commitment to suppliers due to a direct and rational business approach (russo etal., 2016), certain industries witness higher switching costs and lower rates due to investments in long-term relationships (Pick & eisend, 2014). Understanding what factor may influence customer loyalty is very relevant in the indonesia B2B healthcare market. access to efficient healthcare services is a critical need for the indonesian population, which is increasing by 1.25% year on year (BPs, 2022). the widespread expansion of healthcare infrastructure in indonesia has correspondingly led to an escalating demand for diagnostic equipment which gradually grew from 4.9% between 2020 and 2021 to 9.5% between 2021 and 2022 (Ministry of health republic indonesia, 2022). however, the number of healthcare equipment suppliers is almost twice the number of hospitals in indonesia (Ministry of health republic indonesia, 2022). Moreover, rather than as a producer, these suppliers act as distributors for imported products dominated by only several major brands, resulting in a lack of product differentiation and intensifying the competition. amidst this intense competition, predicting and understanding business consumer preferences becomes crucial for supplier to strategize and enhance loyalty (rauyruen & Miller, 2007). however, few studies have as delved into loyalty within the healthcare sector. given the varied outcomes observed in the relationship quality theory and recognizing the existing research gap within the healthcare sector, this study aims to examine the relationship between trust in suppliers, perceived value, switching costs, and loyalty between private hospitals and healthcare equipment providers. We specifically focus on private hospitals due to their need to independently undertake infrastructure development within the competitive landscape of the healthcare industry (ghandour etal., 2022). consequently, they prioritize substantial investments in cutting-edge infrastructure, quality diagnostic equipment, a highly skilled medical workforce, and a commitment to maintaining a hygienic and supportive environment conducive to patient well-being to remain competitive (Fatima et al., 2018). Moreover, with approximately 62.7% of hospitals in indonesia being private and experiencing continuous growth (Ministry of health republic indonesia, 2022), understanding the behavior and features of private hospitals will provide valuable insights into the healthcare equipment market. there are several noteworthy contributions from this study: First, this study address inconsistencies in research findings concerning the relationship quality theory, where trust fosters loyalty in the B2B context. this is particularly crucial given the limited discussion on these variables in the B2B context, especially within the healthcare and diagnostic equipment market. second, the study’s exclusive focus on private hospitals, which enjoy relative independence in supplier decision-making compared to public hospitals in indonesia, adds relevance and significance to its findings. Previous studies that combined private and public hospitals, resulting in biased outcomes due to the different business orientations of these hospital types. third, this study identifies the role of switching cost in the loyalty in health equipment market, a factor which usually overlooked in the loyalty studies. Fourth, this study’s use of a well-measured sample selection technique involving approximately 224 samples from a total around 1938 private hospitals, adding robustness to the study’s findings. cOgent BUsiness & ManageMent 3 in the following sections, we will delve into discussion on the review of the relevant literature, development of the hypothesis. outline the methodology employed and present a result and discussion of the findings. the study concludes with a discussion of the implications of the research as well as potential limitations. Literature review and hypothesis development Theoretical framework grounded in social psychology, relationship Quality represents a pivotal aspect of relationship marketing, emphasizing the exchange dynamics between suppliers and consumers (a. Wong & Zhou, 2013). initially introduced by Berry in 1983, relationship marketing underscores the importance of nurturing enduring customer relationships to attract, retain, and enhance customer engagement (Berl, 1985). at the core of all relationship marketing lies the provision of incentives to encourage customer loyalty. these incentives may encompass supplementary services, relationship-based pricing, or other forms of value, ensuring customers have compelling reasons to remain loyal to their suppliers (Berry, 2002). loyalty becomes especially important as suppliers must acknowledge that acquiring new customers is more costly than retaining existing ones (a. Wong & Zhou, 2013). the concept of relationship quality encompasses both satisfaction and trust, with trust being a foundational element in fostering enduring relationships (crosby etal., 1990). Within the context of B2B interactions, trust extends beyond product quality, including trust in word-of-mouth recommendations and the value derived from the relationships between business consumers and suppliers (he et al., 2018). each interaction influences customers’ evaluations and perceptions of relationship quality, ultimately shaping repeat purchase behavior (Bitner, 1990). to understand how trust influences loyalty, one can turn to the social exchange theory. this theory states that human relationships evolve through subjective cost-benefit analyses, prompting individuals to repeat rewarded actions, thereby increasing the likelihood of recurrence. it underscores that social relationships are founded on mutual trust and reciprocal intentions, with actions contingent upon anticipated rewards from others. this mutually beneficial process involves exchanges based on both social and economic principles. When both partners exhibit commitment, trust, and mutual reliance on each other, those will foster a loyal relationship (arthur et al., 2023). social exchanges theory has been applied as a theoretical framework to enhance customer loyalty through, for example, employee competence (hsiao et al., 2023), relational benefits (lee et al., 2023), and community trust on the brand (sethi et al., 2024). in the context of B2B partnerships, social exchange theory emphasizes interactions for benefit exchanges and cost-sharing between partners over time (rindfleisch & heide, 1997). it suggests that the accumulation of value from previous transactions fosters trust formation, thereby extending the theory of perceived value. additionally, there exists a positive relationship between sustainable business practices and B2B loyalty, rooted in social exchange theory (Yuen et al., 2018). trust and commitment, often stemming from effective communication, shared values, and high exit barriers, lead to reliance between partners and nurture long-term relationships. (Morgan & hunt, 1994). social exchange theory, thus, explains how business partners reach decisions and achieve states of loyalty, trust, and satisfaction. Loyalty and trust in B2B in the business context, loyalty refers to the steadfast commitment of consumers to continue purchasing or subscribing to their preferred products or services in the future, regardless of external influences or marketing strategies that may attempt to sway their behavior (kotler & keller, 2017; reynoso, 2010). customer loyalty is understood as the psychological attachment and advocacy demonstrated by customers towards their suppliers (cen & li, 2019). in B2B market, loyalty is not only reflected in repeated purchases but also in affective and normative commitment attitudes, which are manifested from the development of trust and confidence in the ability of business partners to act in the best interests of consumers (Čater & Čater, 2010). the loyalty of business consumers is largely influenced by the quality of products and services provided by suppliers, as 4 a. rinenggO etal. well as by the extent to which suppliers support customer interests and can be trusted by consumers (Belanche et al., 2014; chen et al., 2015; Van tonder & nel, 2018; Wei et al., 2019). this trust forms the foundation for building strong business relationships, underscoring its essential role in B2B interactions. strong relationships discourage customers from switching to other suppliers due to the perceived value and potential economic benefits associated with continued relationship (Padgett etal., 2020). While trust in suppliers directly influences sustained purchasing intentions, it also indirectly contributes to consumers’ confidence and trust in the supplier’s product brand (Zhao et al., 2019). however, building trust requires effort, time, and short-term investments from suppliers. nevertheless, these efforts can result in valuable word-of-mouth recommendations, which are often considered the most reliable form of advertising (Bardauskaite, 2014). Previous research into B2B transactions has shown that trust in suppliers is crucial for the long-term success of business relationships based on supplier integrity and goodwill (Van tonder & nel, 2018). support services provided by suppliers, which manifested into trust, can differentiate them from competitors and serve as strategic tools for fostering B2B loyalty. Further investigations into B2B loyalty have demonstrated the positive impact of trust in suppliers on customer loyalty across various industries and geographical locations (Biedenbach et al., 2019; Mubarik et al., 2016; Paparoidamis et al., 2019). this underscores the significance of trust in maintaining loyalty of customer. H1: Trust in the supplier significantly influences loyalty. Perceived value according to kotler & keller (2017) and Zauner et al. (2015), customer perceived value results from an evaluation conducted by consumers and is influenced by two main factors: total customer benefit and total customer cost. the evaluation incorporates both cognitive and affective evaluations (Zauner et al., 2015). generally, literature suggests that those values can be derived from four aspects: economic (price), functional (quality or performance), emotional (pleasure and satisfaction), and social utility, such as the concepts and values embraced by oneself or an organization (callarisa Fiol etal., 2011; grace & lo iacono, 2015). literature indicates that trust has close relationship with customer perceived value (aw et al., 2019; chang etal., 2020; Zauner etal., 2015). chang etal. (2020) argues that trust in the information provided by product suppliers positively influences consumer perceived value. in the B2B context, the buyers often make substantial purchases, prompting them to seek trustworthy sellers, which enhances perceived value and facilitates quick online transactions. even more, research indicates that perceived value mediates trust in product information (which includes a strong element of trust in the seller) and the desire to make repeat purchases, establish loyalty of the customer (chang et al., 2020). in the products and services industry, consumers perceive value from the quality of services provided by service organizations can foster dependency among consumers. theoretical perspectives suggest that this is driven by consumer trust in the organization providing the services (gidaković & Zabkar, 2021). the mediating role of perceived value resulting from services provided by organizations in the industry to consumers positively influences the emergence of consumer loyalty. another research study by Yuan et al. (2020) shows that the ability, expertise, and trust in third parties (a term used for companies providing goods/services) can shape perceptions of value towards those companies, ultimately impacting the level of customer loyalty in B2B settings. Overall, this research indicates that business consumer loyalty is influenced by the attitudes of product and service providers that shape perceived value in the minds of consumers. another research in B2B e-marketplace also shows that perceived value positively influences customer loyalty (Janita & Miranda, 2013). H2: Trust in the supplier significantly influences perceived value. H3: Perceived value significantly influences loyalty. H4: Perceived value serves as a mediator between trust in the supplier and loyalty. cOgent BUsiness & ManageMent 5 Switching cost in addition to trust and value, one of the driving factors to keep consumers motivated to stick with a product choice is switching costs. switching costs are generally defined as the costs that arise from switching supplier and/or cost arise from holding consumers to stay loyal (temerak & el-Manstrly, 2019). the definition of switching costs encompasses three categories of switching expenses. Firstly, costs related to customers include habits, effort, time, commitments, and expertise. secondly, company-related costs refer to monetary, searching, and learning costs. thirdly, relational switching costs include emotional costs and alternative attractiveness (Bergel & Brock, 2018; k. h. Wong et al., 2019). after switching, the costs are generally not immediately realized, and consumers need time to realize the cost. Due to its attribute to influence loyalty, several previous research analyzed switching cost as a variable moderating the relationship in the business loyalty. Majority of the studies found that switching costs positively moderate the relationship between trust and customer loyalty, where the relationship between trust and loyalty increases when customers perceive high switching costs (kaur & soch, 2018; Pick & eisend, 2014; sohaib, 2022). in the service industry, trust is the most effective loyalty enhancement strategy, when consumers perceive high switching costs. Monetary loss and the loss of special treatment from product distributor can positively be seen as a form of loss due to customers’ loss of perceived benefits as a part of switching costs (el-Manstrly, 2016). Furthermore, research in the banking industry has found that the moderation of switching costs significantly influences the relationship between the perception of high trust in the institution and the willingness of customers to engage in repeat transactions. the higher the switching costs, the higher the trust in the financial service provider and the more loyal the customers are to that institution (sohaib, 2022). however, several studies have found a negative or insignificant relationship. For example, Dayan etal. (2022) found an insignificant moderation of switching cost between satisfaction and customer loyalty among patient in the Uae hospital, implying that level of switching costs does not significantly change or influence the link between patient satisfaction and their loyalty. the result also supported by Platonova et al. (2008) who found that switching cost has no impact on the patient loyalty. Despite this, considering that the insignificant effect was only discovered in the specific business context between patient and healthcare hospital, we base our hypothesis on the majority of studies indicating that switching cost serves as a positive and significant moderator in the trust-loyalty relationship. H5: Switching cost serves as a moderator between trust in the supplier and loyalty. Based on the theory and evidence of previous studies, the study hypotheses were formulated as follows: in this research model (see Figure 1), perceived value serves as a mediator variable while switching cost serves as moderator variable. as described by hair et al. (2017), mediator, or commonly known as intervening variable, is a variable that intervenes in the relationship between two variables. this variable shows the mechanism how the relationship between endogenous and exogenous variables is explained. On the other hand, moderator is a variable that can alter the strength of the relationship between two variables in the model (hair et al., 2017). Figure 1. Research model. 6 a. rinenggO etal. Materials and methods Data the research was conducted on Java island, indonesia, encompassing six provinces: Dki Jakarta (the capital city), Banten, West Java, central Java, special region of Yogyakarta, and east Java. Data collection took place between august 2023 and november 2023, focusing on active private hospitals. the selection of private hospitals was based on several considerations. Firstly, private hospitals represent independent healthcare entities competing with other private healthcare providers, prioritizing quality services to patients. secondly, these hospitals rely on self-funding for initial healthcare service investments, operational costs, business expansion, and profit generation, underscoring the importance of strategic asset investment to ensure quality patient care, satisfactory return on investment, and service improvement. in addition, the study targeted hospital who had established partnerships with the provider for at least one year to evaluate their perceived value derived from various aspects such as product functionality, price competitiveness, and emotional and social benefits. the questionnaire serves as the primary instrument in this research, employing closed-ended questions. the number of questionnaires is proportionally adjusted according to the quantity of private hospitals in that region. the sample size in this study is determined using the slovin method, allowing researchers to take samples with a certain level of accuracy, confidence, and error rate. the sample size calculation has a tolerance error limit of 5%-10% (Dania et al., 2019). Due to the large population size of private hospitals, time constraints, limited resources, and the willingness of B2B respondents to contribute information to this study, we set the error margin at 6%, resulting in a total sample size of 224 private hospitals in this study. the questionnaire is designed using the likert scale technique with five response categories, ranging from ‘strongly disagree’ to ‘strongly agree’. respondents need to indicate their degree of agreement with each statement addressed in the questionnaire. the likert scale has advantages as it is easy to formulate and process, and respondents can easily understand how to use the scale. table 1 shows the variables, indicator, and the number of items. the questionnaire script is available in the supplementary file. the questionnaire was given to the director or procurement manager of goods/services in the respective private hospitals. Directors or procurement managers play a crucial role in evaluating and coordinating internally with various stakeholders in the healthcare institution before making purchase decisions. Before conducting the survey, the questionnaire has been reviewed by the ethical committee at Universitas Brawijaya. the distribution of the questionnaire was also approved and authorized by the indonesia Private hospital association or Asosiasi Rumah Sakit Swasta Indonesia (arssi), who issued a permission letter for its circulation. Participation in the questionnaire was voluntary, and respondents had the freedom to decline if they wished. Verbal informed consent was obtained from all participants. the data can be accessed without disclosing any identifying information about the respondents upon request from the corresponding author. Constructs’ validity and composite reliability to determine whether all items in the research instrument are appropriate for measuring the relationships among the variables under investigation, validity and reliability tests are necessary (hair et al., 2017). Validity testing of each item in the instrument assesses whether there is a relationship between the item and the total item score. an item is considered valid when the coefficient significance test Table 1. Variables, indicators, and number of items. Variables indicators number of items sources trust in supplier supplier commitment, supplier service support, supplier capability in business related behaviour, supplier integrity 4(Biedenbach et al., 2019; Van tonder & nel, 2018) Perceived Value Functional, value for the price, emotional, social, benefit from a good relationship 5(Corsaro & snehota, 2010; Zauner et al., 2015) switching Cost effort, time, money, emotional 4(Blut et al., 2016; shen & ahmad, 2022; K. H. Wong et al., 2019) Loyalty Repurchase, recommendation 4(Cen & Li, 2019; neupane, 2015; Reynoso, 2010) cOgent BUsiness & ManageMent 7 against the total item score is conducted. Only valid items are suitable for use in the research (Malhotra & Birks, 2015). reliability testing is a measure to test consistency of the instrument. to conclude, validity relates to whether this study measures the correct model, while reliability relates to the stability and consistency of the measurement. Validity and reliability testing are conducted until valid and reliable measurements are achieved, and in this study, it is conducted with two questionnaire distributions. For validity testing, factor analysis is employed as a widely used procedure for data reduction and summarization. a crucial statistic used is the assessment of the adequacy of sample values for factor loading in the component matrix. Factor loading signifies the simple correlation between variables and factors. the questionnaire is considered valid if the factor loading value is ≥0.6 (Malhotra & Birks, 2015). additionally, discriminant validity is assessed using the Fornell-larcker criterion to examine the value of cross-loading factors, which determines whether the constructs have adequate discrimination. to be deemed valid, the constructs must have greater values compared to the loading with other constructs. Based on the validity test, it is found that all indicators are declared valid as they have factor loading greater than 0.6, indicating no correlation between indicators (see table 2). Furthermore, the test shows Table 2. Validity and reliability test. Variable and indicator Validity Reliability item Factor loading (CR) (AVE) Cronbach’s alpha Trust in supplier Commitment ts1: the healthcare equipment distributor has a strong commitment to us. 0.84 0.949 0.823 0.928 service support ts2: the healthcare equipment distributor provides excellent services to us. 0.95 Capability ts3: the healthcare equipment distributor demonstrates competence in their field. 0.92 integrity ts4: the healthcare equipment distributor exhibits high integrity. 0.92 Perceived Value Functional Value PV1: the functional capabilities of the product i receive align with what we pay for. 0.82 0.911 0.673 0.878 Value for the Price PV2: the healthcare equipment distributor provides reasonable product prices, commensurate with the benefits we receive. 0.76 emotional Value PV3: i am satisfied with the products i use. 0.81 social Value PV4: the brand of the products we use aligns with our values, beyond the product’s functionality. 0.88 Benefit from a Relationship PV5: the healthcare equipment distributor supports our needs. 0.83 Switching Cost effort Cost sC1: switching to a new distributor will consume a lot of energy 0.90 0.903 0.7 0.858 time Cost sC2: switching to a new distributor will consume a lot of time. 0.87 Money Cost sC3: switching to a new distributor can incur money costs 0.79 emotional Cost sC4: switching to a new distributor can result in loss of relationship with previous medical equipment suppliers. 0.79 Loyalty Repurchase LY1: i am loyal to using a trusted brand. 0.78 0.909 0.716 0.866 LY2: i will continue to purchase from my preferred healthcare equipment distributor for the next few years. 0.79 endorsing LY3: i will recommend my preferred brand to colleagues. 0.91 LY4: i will recommend my preferred healthcare equipment distributor to colleagues. 0.90 14 a. rinenggO etal. 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