Rinenggo, Aswinda u; Sudi o, Achmad; Suna yo; Hussein, Ananda Sabil
A icle
T us wo hiness in Indonesia heal hca e: os e ing loyal y
in B2B ela ionships
Cogen Business & Managemen
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Sugges ed Ci a ion: Rinenggo, Aswinda u; Sudi o, Achmad; Suna yo; Hussein, Ananda Sabil (2024) :
T us wo hiness in Indonesia heal hca e: os e ing loyal y in B2B ela ionships, Cogen Business &
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T us wo hiness in Indonesia heal hca e:
os e ing loyal y in B2B ela ionships
Aswinda u Rinenggo, Achmad Sudi o, Suna yo & Ananda Sabil Hussein
To ci e his a icle: Aswinda u Rinenggo, Achmad Sudi o, Suna yo & Ananda Sabil Hussein
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2024, VoL. 11, no. 1, 2371991
T us wo hiness in Indonesia heal hca e: os e ing loyal y in B2B
ela ionships
aswinda u inenggo , achmad sudi o , suna yo and ananda sabil hussein
Depa men o Managemen , Facul y o economics and Business, uni e si as B awijaya, Malang, indonesia
ABSTRACT
he expansion o heal hca e in as uc u e has led o a su ge in demand o diagnos ic
equipmen , p esen ing oppo uni ies o heal hca e equipmen supplie s. howe e , he
ma ke aces challenges, including in ense compe i ion exace ba ed by limi ed p oduc
di e en ia ion and a su plus o supplie s. amids his compe i i e landscape,
unde s anding he ac o s in luencing business consume p e e ences and loyal y
becomes c ucial o supplie s. heo e ical pe spec i es highligh us as a ounda ional
elemen in business- o-business (B2B) ela ionships, in luencing loyal y. Pe cei ed alue,
e lec ing consume assessmen s o p oduc quali y, p icing, and ela ional bene i s,
media es his ela ionship. ne e heless, esea ch on us and loyal y in B2B heal hca e
ma ke s, pa icula ly in indonesia, emains limi ed. Fu he mo e, he ole o swi ching
cos s in shaping loyal y, especially in he con ex o heal hca e equipmen , is
unde explo ed. employing s uc u al equa ion Modeling-Pa ial leas squa es (seM-Pls),
his s udy in es iga es us , pe cei ed alue, swi ching cos s, and loyal y dynamics
be ween p i a e hospi als and equipmen p o ide s in Ja a, indonesia. Findings e eal
ha us signi ican ly in luences loyal y, wi h pe cei ed alue pa ially media ing he
us -loyal y ela ionship. su p isingly, swi ching cos s do no mode a e he us -loyal y
ela ionship. his s udy’s con ibu ions include cla i ying us and loyal y dynamics in
B2B heal hca e ma ke s in indonesia and unde sco ing he impo ance o pe cei ed
alue in d i ing loyal y. Despi e limi a ions, such as geog aphic scope, his esea ch
in o ms s a egic ma ke ing and ela ionship managemen in he heal hca e equipmen
sec o .
In oduc ion
De eloping long-las ing ela ionships wi h cus ome s is conside ed c ucial, as losing cus ome s is cos ly,
especially in he business o business (B2B) ma ke ( aimondo e al., 2008). One main heo e ical concep
shaping loyal y is ela ionship quali y, pa icula ly s emming om us , as p oposed by Be y (1983).
us has been widely discussed as one o he c ucial ac o s o os e ing loyal y o he cus ome .
esea che s such as hennig- hu au e al. (2004), Bojei and a ya y, (2010), Ba aineh e al. (2015) ha e
sugges ed ha good ela ionship quali y e lec s success ul ela ionship ac i i ies, cha ac e ized by a
ecip ocal exchange o cos s and bene i s inhe en in business ansac ions, aligning wi h he p inciples
o social exchange heo y (cook & ice, 2020; homans, 1958). his exchange o cos s and bene i s shapes
pe cei ed alue, as B2B consume s pe cei e he alue and bene i s ecei ed om a ious aspec s ela ed
o supplie suppo and commi men (Yuan e al., 2020). esea che s ypically de ine pe cei ed alue as
he media ing ac o in he ela ionship be ween us and loyal y, as consume s’ us in p oduc in o -
ma ion, quali y, and se ice can signi ican ly in luence pe cei ed alue, he eby os e ing loyal y e ec-
i ely (aw e al., 2019; Yuan e al., 2020; Zaune e al., 2015).
© 2024 he au ho (s). Published by in o ma uK Limi ed, ading as aylo & F ancis g oup
CONTACT aswinda u Rinenggo [email p o ec ed].ac.id Depa men o Managemen , Facul y o economics and Business,
uni e si as B awijaya, Malang 65145, indonesia.
supplemen al da a o his a icle can be accessed online a h ps://doi.o g/10.1080/23311975.2024.2371991.
h ps://doi.o g/10.1080/23311975.2024.2371991
his is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons a ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0/), which
pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. he e ms on which his a icle has been
published allow he pos ing o he accep ed Manusc ip in a eposi o y by he au ho (s) o wi h hei consen .
ARTICLE HISTORY
ecei ed 22 Feb ua y
2024
e ised 16 May 2024
accep ed 18 June 2024
KEYWORDS
us ; loyal y; B2B;
heal hca e; swi ching
cos ; pe cei ed alue
REVIEWING EDITOR
Osikhuemhe Okwilagwe,
Bou nemou h Uni e si y
Facul y o Managemen :
Bou nemou h Uni e si y
Business school, Uni ed
kingdom o g ea B i ain
and no he n i eland
SUBJECTS
Business, Managemen
and accoun ing; indus y
& indus ial s udies;
economics; Ma ke ing
2 a. inenggO e al.
While li e a u e indica es ha us se es as a psychological ounda ion in he ma ke ansac ion, a
opic somewha unde explo ed in he mo i a ion o cus ome beha io in B2B ma ke (che y, 2015).
Fu he mo e, inconsis encies pe sis in he ela ionship be ween us and loyal y. While ecen s udies
demons a e a signi ican posi i e co ela ion be ween us and loyal y (see Biedenbach e al., 2019;
cabanelas e al., 2024; cui e al., 2023; Zhao e al., 2019), bo h di ec ly and indi ec ly, o he s e eal a
non-signi ican ela ionship, con adic ing ela ionship quali y heo y (see hong & cho, 2011; kau &
soch, 2018).
in addi ion, al hough many s udies ypically adop ela ionship quali y heo y o build and main-
ain cus ome loyal y, ecen s udies iden i y one ac o ha may in luence he e ec i eness o hese
s a egies; swi ching cos s (el-Mans ly, 2016; iqbal e al., 2023). cus ome s incu cos s when hey
ein es ime o swi ch o di e en p oduc and se ice p o ide s— ime spen , e o exe ed, ene gy,
and knowledge acqui ed, all o which may a ec cus ome loyal y o a pa icula supplie (hess &
en ic ica , 2003; usso e al., 2016). Mi al (2016) sugges s ha cus ome s end o emain loyal o
a supplie when swi ching o a compe i o is pe cei ed as oo cos ly, as suppo ed by D. . nguyen
e al. (2020). howe e , he in luence o swi ching cos s on cus ome loyal y a ies based on ma ke
cha ac e is ics. While B2B buye s gene ally exhibi low swi ching cos s and minimal commi men o
supplie s due o a di ec and a ional business app oach ( usso e al., 2016), ce ain indus ies wi ness
highe swi ching cos s and lowe a es due o in es men s in long- e m ela ionships (Pick &
eisend, 2014).
Unde s anding wha ac o may in luence cus ome loyal y is e y ele an in he indonesia B2B
heal hca e ma ke . access o e icien heal hca e se ices is a c i ical need o he indonesian popula ion,
which is inc easing by 1.25% yea on yea (BPs, 2022). he widesp ead expansion o heal hca e in a-
s uc u e in indonesia has co espondingly led o an escala ing demand o diagnos ic equipmen which
g adually g ew om 4.9% be ween 2020 and 2021 o 9.5% be ween 2021 and 2022 (Minis y o heal h
epublic indonesia, 2022). howe e , he numbe o heal hca e equipmen supplie s is almos wice he
numbe o hospi als in indonesia (Minis y o heal h epublic indonesia, 2022). Mo eo e , a he han as
a p oduce , hese supplie s ac as dis ibu o s o impo ed p oduc s domina ed by only se e al majo
b ands, esul ing in a lack o p oduc di e en ia ion and in ensi ying he compe i ion. amids his in ense
compe i ion, p edic ing and unde s anding business consume p e e ences becomes c ucial o supplie
o s a egize and enhance loyal y ( auy uen & Mille , 2007). howe e , ew s udies ha e as del ed in o
loyal y wi hin he heal hca e sec o .
gi en he a ied ou comes obse ed in he ela ionship quali y heo y and ecognizing he exis ing
esea ch gap wi hin he heal hca e sec o , his s udy aims o examine he ela ionship be ween us in
supplie s, pe cei ed alue, swi ching cos s, and loyal y be ween p i a e hospi als and heal hca e equip-
men p o ide s. We speci ically ocus on p i a e hospi als due o hei need o independen ly unde ake
in as uc u e de elopmen wi hin he compe i i e landscape o he heal hca e indus y (ghandou e al.,
2022). consequen ly, hey p io i ize subs an ial in es men s in cu ing-edge in as uc u e, quali y diag-
nos ic equipmen , a highly skilled medical wo k o ce, and a commi men o main aining a hygienic and
suppo i e en i onmen conduci e o pa ien well-being o emain compe i i e (Fa ima e al., 2018).
Mo eo e , wi h app oxima ely 62.7% o hospi als in indonesia being p i a e and expe iencing con inuous
g ow h (Minis y o heal h epublic indonesia, 2022), unde s anding he beha io and ea u es o p i a e
hospi als will p o ide aluable insigh s in o he heal hca e equipmen ma ke .
he e a e se e al no ewo hy con ibu ions om his s udy: Fi s , his s udy add ess inconsis encies in
esea ch indings conce ning he ela ionship quali y heo y, whe e us os e s loyal y in he B2B con-
ex . his is pa icula ly c ucial gi en he limi ed discussion on hese a iables in he B2B con ex , espe-
cially wi hin he heal hca e and diagnos ic equipmen ma ke . second, he s udy’s exclusi e ocus on
p i a e hospi als, which enjoy ela i e independence in supplie decision-making compa ed o public
hospi als in indonesia, adds ele ance and signi icance o i s indings. P e ious s udies ha combined
p i a e and public hospi als, esul ing in biased ou comes due o he di e en business o ien a ions o
hese hospi al ypes. hi d, his s udy iden i ies he ole o swi ching cos in he loyal y in heal h equip-
men ma ke , a ac o which usually o e looked in he loyal y s udies. Fou h, his s udy’s use o a
well-measu ed sample selec ion echnique in ol ing app oxima ely 224 samples om a o al a ound
1938 p i a e hospi als, adding obus ness o he s udy’s indings.
cOgen BUsiness & ManageMen 3
in he ollowing sec ions, we will del e in o discussion on he e iew o he ele an li e a u e, de el-
opmen o he hypo hesis. ou line he me hodology employed and p esen a esul and discussion o he
indings. he s udy concludes wi h a discussion o he implica ions o he esea ch as well as po en ial
limi a ions.
Li e a u e e iew and hypo hesis de elopmen
Theo e ical amewo k
g ounded in social psychology, ela ionship Quali y ep esen s a pi o al aspec o ela ionship ma ke ing,
emphasizing he exchange dynamics be ween supplie s and consume s (a. Wong & Zhou, 2013). ini ially
in oduced by Be y in 1983, ela ionship ma ke ing unde sco es he impo ance o nu u ing endu ing
cus ome ela ionships o a ac , e ain, and enhance cus ome engagemen (Be l, 1985). a he co e o
all ela ionship ma ke ing lies he p o ision o incen i es o encou age cus ome loyal y. hese incen i es
may encompass supplemen a y se ices, ela ionship-based p icing, o o he o ms o alue, ensu ing
cus ome s ha e compelling easons o emain loyal o hei supplie s (Be y, 2002). loyal y becomes
especially impo an as supplie s mus acknowledge ha acqui ing new cus ome s is mo e cos ly han
e aining exis ing ones (a. Wong & Zhou, 2013).
he concep o ela ionship quali y encompasses bo h sa is ac ion and us , wi h us being a oun-
da ional elemen in os e ing endu ing ela ionships (c osby e al., 1990). Wi hin he con ex o B2B in e -
ac ions, us ex ends beyond p oduc quali y, including us in wo d-o -mou h ecommenda ions and
he alue de i ed om he ela ionships be ween business consume s and supplie s (he e al., 2018).
each in e ac ion in luences cus ome s’ e alua ions and pe cep ions o ela ionship quali y, ul ima ely
shaping epea pu chase beha io (Bi ne , 1990).
o unde s and how us in luences loyal y, one can u n o he social exchange heo y. his heo y
s a es ha human ela ionships e ol e h ough subjec i e cos -bene i analyses, p omp ing indi iduals o
epea ewa ded ac ions, he eby inc easing he likelihood o ecu ence. i unde sco es ha social ela-
ionships a e ounded on mu ual us and ecip ocal in en ions, wi h ac ions con ingen upon an ici-
pa ed ewa ds om o he s. his mu ually bene icial p ocess in ol es exchanges based on bo h social and
economic p inciples. When bo h pa ne s exhibi commi men , us , and mu ual eliance on each o he ,
hose will os e a loyal ela ionship (a hu e al., 2023). social exchanges heo y has been applied as a
heo e ical amewo k o enhance cus ome loyal y h ough, o example, employee compe ence (hsiao
e al., 2023), ela ional bene i s (lee e al., 2023), and communi y us on he b and (se hi e al., 2024).
in he con ex o B2B pa ne ships, social exchange heo y emphasizes in e ac ions o bene i
exchanges and cos -sha ing be ween pa ne s o e ime ( ind leisch & heide, 1997). i sugges s ha he
accumula ion o alue om p e ious ansac ions os e s us o ma ion, he eby ex ending he heo y
o pe cei ed alue. addi ionally, he e exis s a posi i e ela ionship be ween sus ainable business p ac-
ices and B2B loyal y, oo ed in social exchange heo y (Yuen e al., 2018). us and commi men , o en
s emming om e ec i e communica ion, sha ed alues, and high exi ba ie s, lead o eliance be ween
pa ne s and nu u e long- e m ela ionships. (Mo gan & hun , 1994). social exchange heo y, hus,
explains how business pa ne s each decisions and achie e s a es o loyal y, us , and sa is ac ion.
Loyal y and us in B2B
in he business con ex , loyal y e e s o he s ead as commi men o consume s o con inue pu chasing
o subsc ibing o hei p e e ed p oduc s o se ices in he u u e, ega dless o ex e nal in luences o
ma ke ing s a egies ha may a emp o sway hei beha io (ko le & kelle , 2017; eynoso, 2010).
cus ome loyal y is unde s ood as he psychological a achmen and ad ocacy demons a ed by cus om-
e s owa ds hei supplie s (cen & li, 2019).
in B2B ma ke , loyal y is no only e lec ed in epea ed pu chases bu also in a ec i e and no ma i e
commi men a i udes, which a e mani es ed om he de elopmen o us and con idence in he abili y
o business pa ne s o ac in he bes in e es s o consume s (Ča e & Ča e , 2010). he loyal y o busi-
ness consume s is la gely in luenced by he quali y o p oduc s and se ices p o ided by supplie s, as
4 a. inenggO e al.
well as by he ex en o which supplie s suppo cus ome in e es s and can be us ed by consume s
(Belanche e al., 2014; chen e al., 2015; Van onde & nel, 2018; Wei e al., 2019). his us o ms he
ounda ion o building s ong business ela ionships, unde sco ing i s essen ial ole in B2B in e ac ions.
s ong ela ionships discou age cus ome s om swi ching o o he supplie s due o he pe cei ed alue
and po en ial economic bene i s associa ed wi h con inued ela ionship (Padge e al., 2020). While us
in supplie s di ec ly in luences sus ained pu chasing in en ions, i also indi ec ly con ibu es o consum-
e s’ con idence and us in he supplie ’s p oduc b and (Zhao e al., 2019). howe e , building us
equi es e o , ime, and sho - e m in es men s om supplie s. ne e heless, hese e o s can esul in
aluable wo d-o -mou h ecommenda ions, which a e o en conside ed he mos eliable o m o ad e -
ising (Ba dauskai e, 2014).
P e ious esea ch in o B2B ansac ions has shown ha us in supplie s is c ucial o he long- e m
success o business ela ionships based on supplie in eg i y and goodwill (Van onde & nel, 2018).
suppo se ices p o ided by supplie s, which mani es ed in o us , can di e en ia e hem om compe -
i o s and se e as s a egic ools o os e ing B2B loyal y. Fu he in es iga ions in o B2B loyal y ha e
demons a ed he posi i e impac o us in supplie s on cus ome loyal y ac oss a ious indus ies and
geog aphical loca ions (Biedenbach e al., 2019; Muba ik e al., 2016; Papa oidamis e al., 2019). his
unde sco es he signi icance o us in main aining loyal y o cus ome .
H1: T us in he supplie signi ican ly in luences loyal y.
Pe cei ed alue
acco ding o ko le & kelle (2017) and Zaune e al. (2015), cus ome pe cei ed alue esul s om an
e alua ion conduc ed by consume s and is in luenced by wo main ac o s: o al cus ome bene i and o al
cus ome cos . he e alua ion inco po a es bo h cogni i e and a ec i e e alua ions (Zaune e al., 2015).
gene ally, li e a u e sugges s ha hose alues can be de i ed om ou aspec s: economic (p ice), unc-
ional (quali y o pe o mance), emo ional (pleasu e and sa is ac ion), and social u ili y, such as he con-
cep s and alues emb aced by onesel o an o ganiza ion (calla isa Fiol e al., 2011; g ace & lo iacono, 2015).
li e a u e indica es ha us has close ela ionship wi h cus ome pe cei ed alue (aw e al., 2019;
chang e al., 2020; Zaune e al., 2015). chang e al. (2020) a gues ha us in he in o ma ion p o ided
by p oduc supplie s posi i ely in luences consume pe cei ed alue. in he B2B con ex , he buye s
o en make subs an ial pu chases, p omp ing hem o seek us wo hy selle s, which enhances pe cei ed
alue and acili a es quick online ansac ions. e en mo e, esea ch indica es ha pe cei ed alue medi-
a es us in p oduc in o ma ion (which includes a s ong elemen o us in he selle ) and he desi e
o make epea pu chases, es ablish loyal y o he cus ome (chang e al., 2020).
in he p oduc s and se ices indus y, consume s pe cei e alue om he quali y o se ices p o ided
by se ice o ganiza ions can os e dependency among consume s. heo e ical pe spec i es sugges ha
his is d i en by consume us in he o ganiza ion p o iding he se ices (gidako ić & Zabka , 2021).
he media ing ole o pe cei ed alue esul ing om se ices p o ided by o ganiza ions in he indus y
o consume s posi i ely in luences he eme gence o consume loyal y. ano he esea ch s udy by Yuan
e al. (2020) shows ha he abili y, expe ise, and us in hi d pa ies (a e m used o companies p o-
iding goods/se ices) can shape pe cep ions o alue owa ds hose companies, ul ima ely impac ing
he le el o cus ome loyal y in B2B se ings. O e all, his esea ch indica es ha business consume
loyal y is in luenced by he a i udes o p oduc and se ice p o ide s ha shape pe cei ed alue in he
minds o consume s. ano he esea ch in B2B e-ma ke place also shows ha pe cei ed alue posi i ely
in luences cus ome loyal y (Jani a & Mi anda, 2013).
H2: T us in he supplie signi ican ly in luences pe cei ed alue.
H3: Pe cei ed alue signi ican ly in luences loyal y.
H4: Pe cei ed alue se es as a media o be ween us in he supplie and loyal y.
cOgen BUsiness & ManageMen 5
Swi ching cos
in addi ion o us and alue, one o he d i ing ac o s o keep consume s mo i a ed o s ick wi h a
p oduc choice is swi ching cos s. swi ching cos s a e gene ally de ined as he cos s ha a ise om
swi ching supplie and/o cos a ise om holding consume s o s ay loyal ( eme ak & el-Mans ly,
2019). he de ini ion o swi ching cos s encompasses h ee ca ego ies o swi ching expenses. Fi s ly,
cos s ela ed o cus ome s include habi s, e o , ime, commi men s, and expe ise. secondly,
company- ela ed cos s e e o mone a y, sea ching, and lea ning cos s. hi dly, ela ional swi ching
cos s include emo ional cos s and al e na i e a ac i eness (Be gel & B ock, 2018; k. h. Wong e al.,
2019). a e swi ching, he cos s a e gene ally no immedia ely ealized, and consume s need ime o
ealize he cos .
Due o i s a ibu e o in luence loyal y, se e al p e ious esea ch analyzed swi ching cos as a
a iable mode a ing he ela ionship in he business loyal y. Majo i y o he s udies ound ha
swi ching cos s posi i ely mode a e he ela ionship be ween us and cus ome loyal y, whe e he
ela ionship be ween us and loyal y inc eases when cus ome s pe cei e high swi ching cos s (kau
& soch, 2018; Pick & eisend, 2014; sohaib, 2022). in he se ice indus y, us is he mos e ec i e
loyal y enhancemen s a egy, when consume s pe cei e high swi ching cos s. Mone a y loss and
he loss o special ea men om p oduc dis ibu o can posi i ely be seen as a o m o loss due
o cus ome s’ loss o pe cei ed bene i s as a pa o swi ching cos s (el-Mans ly, 2016). Fu he mo e,
esea ch in he banking indus y has ound ha he mode a ion o swi ching cos s signi ican ly
in luences he ela ionship be ween he pe cep ion o high us in he ins i u ion and he willing-
ness o cus ome s o engage in epea ansac ions. he highe he swi ching cos s, he highe he
us in he inancial se ice p o ide and he mo e loyal he cus ome s a e o ha ins i u ion
(sohaib, 2022).
howe e , se e al s udies ha e ound a nega i e o insigni ican ela ionship. Fo example, Dayan
e al. (2022) ound an insigni ican mode a ion o swi ching cos be ween sa is ac ion and cus ome
loyal y among pa ien in he Uae hospi al, implying ha le el o swi ching cos s does no signi i-
can ly change o in luence he link be ween pa ien sa is ac ion and hei loyal y. he esul also
suppo ed by Pla ono a e al. (2008) who ound ha swi ching cos has no impac on he pa ien
loyal y. Despi e his, conside ing ha he insigni ican e ec was only disco e ed in he speci ic
business con ex be ween pa ien and heal hca e hospi al, we base ou hypo hesis on he majo i y
o s udies indica ing ha swi ching cos se es as a posi i e and signi ican mode a o in he
us -loyal y ela ionship.
H5: Swi ching cos se es as a mode a o be ween us in he supplie and loyal y.
Based on he heo y and e idence o p e ious s udies, he s udy hypo heses we e o mula ed as
ollows:
in his esea ch model (see Figu e 1), pe cei ed alue se es as a media o a iable while swi ching
cos se es as mode a o a iable. as desc ibed by hai e al. (2017), media o , o commonly known as
in e ening a iable, is a a iable ha in e enes in he ela ionship be ween wo a iables. his a iable
shows he mechanism how he ela ionship be ween endogenous and exogenous a iables is explained.
On he o he hand, mode a o is a a iable ha can al e he s eng h o he ela ionship be ween wo
a iables in he model (hai e al., 2017).
Figu e 1. Resea ch model.
6 a. inenggO e al.
Ma e ials and me hods
Da a
he esea ch was conduc ed on Ja a island, indonesia, encompassing six p o inces: Dki Jaka a ( he capi al
ci y), Ban en, Wes Ja a, cen al Ja a, special egion o Yogyaka a, and eas Ja a. Da a collec ion ook place
be ween augus 2023 and no embe 2023, ocusing on ac i e p i a e hospi als. he selec ion o p i a e hos-
pi als was based on se e al conside a ions. Fi s ly, p i a e hospi als ep esen independen heal hca e en i ies
compe ing wi h o he p i a e heal hca e p o ide s, p io i izing quali y se ices o pa ien s. secondly, hese
hospi als ely on sel - unding o ini ial heal hca e se ice in es men s, ope a ional cos s, business expansion,
and p o i gene a ion, unde sco ing he impo ance o s a egic asse in es men o ensu e quali y pa ien
ca e, sa is ac o y e u n on in es men , and se ice imp o emen . in addi ion, he s udy a ge ed hospi al who
had es ablished pa ne ships wi h he p o ide o a leas one yea o e alua e hei pe cei ed alue de i ed
om a ious aspec s such as p oduc unc ionali y, p ice compe i i eness, and emo ional and social bene i s.
he ques ionnai e se es as he p ima y ins umen in his esea ch, employing closed-ended ques ions.
he numbe o ques ionnai es is p opo ionally adjus ed acco ding o he quan i y o p i a e hospi als in
ha egion. he sample size in his s udy is de e mined using he slo in me hod, allowing esea che s o
ake samples wi h a ce ain le el o accu acy, con idence, and e o a e. he sample size calcula ion has a
ole ance e o limi o 5%-10% (Dania e al., 2019). Due o he la ge popula ion size o p i a e hospi als,
ime cons ain s, limi ed esou ces, and he willingness o B2B esponden s o con ibu e in o ma ion o his
s udy, we se he e o ma gin a 6%, esul ing in a o al sample size o 224 p i a e hospi als in his s udy.
he ques ionnai e is designed using he like scale echnique wi h i e esponse ca ego ies, anging
om ‘s ongly disag ee’ o ‘s ongly ag ee’. esponden s need o indica e hei deg ee o ag eemen wi h
each s a emen add essed in he ques ionnai e. he like scale has ad an ages as i is easy o o mula e
and p ocess, and esponden s can easily unde s and how o use he scale. able 1 shows he a iables,
indica o , and he numbe o i ems. he ques ionnai e sc ip is a ailable in he supplemen a y ile.
he ques ionnai e was gi en o he di ec o o p ocu emen manage o goods/se ices in he espec i e
p i a e hospi als. Di ec o s o p ocu emen manage s play a c ucial ole in e alua ing and coo dina ing in e -
nally wi h a ious s akeholde s in he heal hca e ins i u ion be o e making pu chase decisions. Be o e con-
duc ing he su ey, he ques ionnai e has been e iewed by he e hical commi ee a Uni e si as B awijaya.
he dis ibu ion o he ques ionnai e was also app o ed and au ho ized by he indonesia P i a e hospi al
associa ion o Asosiasi Rumah Saki Swas a Indonesia (a ssi), who issued a pe mission le e o i s ci cula ion.
Pa icipa ion in he ques ionnai e was olun a y, and esponden s had he eedom o decline i hey wished.
Ve bal in o med consen was ob ained om all pa icipan s. he da a can be accessed wi hou disclosing any
iden i ying in o ma ion abou he esponden s upon eques om he co esponding au ho .
Cons uc s’ alidi y and composi e eliabili y
o de e mine whe he all i ems in he esea ch ins umen a e app op ia e o measu ing he ela ion-
ships among he a iables unde in es iga ion, alidi y and eliabili y es s a e necessa y (hai e al.,
2017). Validi y es ing o each i em in he ins umen assesses whe he he e is a ela ionship be ween
he i em and he o al i em sco e. an i em is conside ed alid when he coe icien signi icance es
Table 1. Va iables, indica o s, and numbe o i ems.
Va iables indica o s numbe o i ems sou ces
us in supplie supplie commi men , supplie se ice
suppo , supplie capabili y in
business ela ed beha iou , supplie
in eg i y
4(Biedenbach e al., 2019; Van
onde & nel, 2018)
Pe cei ed Value Func ional, alue o he p ice,
emo ional, social, bene i om a
good ela ionship
5(Co sa o & sneho a, 2010; Zaune
e al., 2015)
swi ching Cos e o , ime, money, emo ional 4(Blu e al., 2016; shen & ahmad,
2022; K. H. Wong e al., 2019)
Loyal y Repu chase, ecommenda ion 4(Cen & Li, 2019; neupane, 2015;
Reynoso, 2010)
cOgen BUsiness & ManageMen 7
agains he o al i em sco e is conduc ed. Only alid i ems a e sui able o use in he esea ch (Malho a
& Bi ks, 2015). eliabili y es ing is a measu e o es consis ency o he ins umen . o conclude, alidi y
ela es o whe he his s udy measu es he co ec model, while eliabili y ela es o he s abili y and
consis ency o he measu emen . Validi y and eliabili y es ing a e conduc ed un il alid and eliable
measu emen s a e achie ed, and in his s udy, i is conduc ed wi h wo ques ionnai e dis ibu ions.
Fo alidi y es ing, ac o analysis is employed as a widely used p ocedu e o da a educ ion and
summa iza ion. a c ucial s a is ic used is he assessmen o he adequacy o sample alues o ac o
loading in he componen ma ix. Fac o loading signi ies he simple co ela ion be ween a iables and
ac o s. he ques ionnai e is conside ed alid i he ac o loading alue is ≥0.6 (Malho a & Bi ks, 2015).
addi ionally, disc iminan alidi y is assessed using he Fo nell-la cke c i e ion o examine he alue o
c oss-loading ac o s, which de e mines whe he he cons uc s ha e adequa e disc imina ion. o be
deemed alid, he cons uc s mus ha e g ea e alues compa ed o he loading wi h o he cons uc s.
Based on he alidi y es , i is ound ha all indica o s a e decla ed alid as hey ha e ac o loading
g ea e han 0.6, indica ing no co ela ion be ween indica o s (see able 2). Fu he mo e, he es shows
Table 2. Validi y and eliabili y es .
Va iable and indica o
Validi y Reliabili y
i em Fac o loading (CR) (AVE) C onbach’s alpha
T us in supplie
Commi men s1: he heal hca e equipmen
dis ibu o has a s ong commi men
o us.
0.84 0.949 0.823 0.928
se ice suppo s2: he heal hca e equipmen
dis ibu o p o ides excellen se ices
o us.
0.95
Capabili y s3: he heal hca e equipmen
dis ibu o demons a es compe ence
in hei ield.
0.92
in eg i y s4: he heal hca e equipmen
dis ibu o exhibi s high in eg i y.
0.92
Pe cei ed Value
Func ional Value PV1: he unc ional capabili ies o he
p oduc i ecei e align wi h wha we
pay o .
0.82 0.911 0.673 0.878
Value o he P ice PV2: he heal hca e equipmen
dis ibu o p o ides easonable
p oduc p ices, commensu a e wi h
he bene i s we ecei e.
0.76
emo ional Value PV3: i am sa is ied wi h he p oduc s i
use.
0.81
social Value PV4: he b and o he p oduc s we use
aligns wi h ou alues, beyond he
p oduc ’s unc ionali y.
0.88
Bene i om a Rela ionship PV5: he heal hca e equipmen
dis ibu o suppo s ou needs.
0.83
Swi ching Cos
e o Cos sC1: swi ching o a new dis ibu o will
consume a lo o ene gy
0.90 0.903 0.7 0.858
ime Cos sC2: swi ching o a new dis ibu o will
consume a lo o ime.
0.87
Money Cos sC3: swi ching o a new dis ibu o can
incu money cos s
0.79
emo ional Cos sC4: swi ching o a new dis ibu o can
esul in loss o ela ionship wi h
p e ious medical equipmen
supplie s.
0.79
Loyal y
Repu chase LY1: i am loyal o using a us ed b and. 0.78 0.909 0.716 0.866
LY2: i will con inue o pu chase om
my p e e ed heal hca e equipmen
dis ibu o o he nex ew yea s.
0.79
endo sing LY3: i will ecommend my p e e ed
b and o colleagues.
0.91
LY4: i will ecommend my p e e ed
heal hca e equipmen dis ibu o o
colleagues.
0.90
14 a. inenggO e al.
Malho a, n. k., & Bi ks, D. F. (2015). Ma ke ing esea ch: An applied app oach (2nd ed.). P en ice hall.
Minis y o heal h epublic indonesia. (2022). Medical equipmen ma ke in Indonesia. h ps://www.kemkes.go.id/
Mi al, B. (2016). e ospec i e: why do cus ome s swi ch? he dynamics o sa is ac ion e sus loyal y. Jou nal o
Se ices Ma ke ing, 30(6), 569–575. h ps://doi.o g/10.1108/JsM-07-2016-0277
Mo gan, . M., & hun , s. D. (1994). he commi men - us heo y o ela ionship ma ke ing. Jou nal o Ma ke ing,
58(3), 20–38. h ps://doi.o g/10.2307/1252308
Muba ik, s., chand an, V., & De adason, e. s. (2016). ela ional capi al quali y and clien loyal y: Fi m-le el e idence
om pha maceu icals, Pakis an. The Lea ning O ganiza ion, 23(1), 43–60. h ps://doi.o g/10.1108/ lO-05-2015-0030
neupane, . (2015). he e ec s o b and image on cus ome sa is ac ion and loyal y in en ion in e ail supe ma ke
chain Uk. In e na ional Jou nal o Social Sciences and Managemen , 2(1), 9–26. h ps://doi.o g/10.3126/ijssm. 2i1.11814
nguyen, D. ., Pham, V. ., an, D. M., & Pham, D. B. . (2020). impac o se ice quali y, cus ome sa is ac ion and
swi ching cos s on cus ome loyal y. The Jou nal o Asian Finance, Economics and Business, 7(8), 395–405. h ps://
doi.o g/10.13106/ja eb.2020. ol7.no8.395
Padge , D., hopkins, c. D., & Williams, Z. (2020). Buye dependence in B2B ela ionships: he ole o supplie in es men s,
commi men o m, and us . Jou nal o Business Resea ch, 119, 13–24. h ps://doi.o g/10.1016/j.jbus es.2020.07.019
Papa oidamis, n. g., ka sikeas, c. s., & chumpi az, . (2019). he ole o supplie pe o mance in building cus ome
us and loyal y: a c oss-coun y examina ion. Indus ial Ma ke ing Managemen , 78, 183–197. h ps://doi.
o g/10.1016/j.indma man.2017.02.005
Pick, D., & eisend, M. (2014). Buye s’ pe cei ed swi ching cos s and swi ching: a me a-analy ic assessmen o hei
an eceden s. Jou nal o he Academy o Ma ke ing Science, 42(2), 186–204. h ps://doi.o g/10.1007/s11747-013-0349-2
Pla ono a, e. a., kennedy, k. n., & shewchuk, . M. (2008). Unde s anding pa ien sa is ac ion, us , and loyal y o p ima-
y ca e physicians. Medical Ca e Resea ch and Re iew: MCRR, 65(6), 696–712. h ps://doi.o g/10.1177/1077558708322863
aimondo, M. a., nino Miceli, g., & cos abile, M. (2008). how ela ionship age mode a es loyal y o ma ion. Jou nal
o Se ice Resea ch, 11(2), 142–160. h ps://doi.o g/10.1177/1094670508324678
auy uen, P., & Mille , k. e. (2007). ela ionship quali y as a p edic o o B2B cus ome loyal y. Jou nal o Business
Resea ch, 60(1), 21–31. h ps://doi.o g/10.1016/j.jbus es.2005.11.006
eynoso, J. (2010). sa is ac ion: a beha io al pe spec i e on he consume . Jou nal o Se ice Managemen , 21(4),
549–551. h ps://doi.o g/10.1108/09564231011066132
ind leisch, a., & heide, J. B. (1997). ansac ion cos analysis: Pas , p esen , and u u e applica ions. Jou nal o
Ma ke ing, 61(4), 30–54. h ps://doi.o g/10.1177/002224299706100403
usso, i., con en e, i., gligo , D. M., & au y, c. W. (2016). o be o no o be (loyal): is he e a ecipe o cus ome
loyal y in he B2B con ex ? Jou nal o Business Resea ch, 69(2), 888–896. h ps://doi.o g/10.1016/j.jbus es.2015.07.002
se hi, a. ., Dash, s., Mish a, a., & cy , D. (2024). ole o communi y us in d i ing b and loyal y in la ge online B2B
communi ies. Jou nal o Business & Indus ial Ma ke ing, 39(2), 256–272. h ps://doi.o g/10.1108/JBiM-10-2022-0469
shen, Y., & ahmad, . (2022). he in luence o b and image and a o abili y owa d ci izens in a p oduc ’s coun y o
o igin on p oduc e alua ion: Mode a ing e ec s o swi ching cos s. F on ie s in Psychology, 13, 740269. h ps://doi.
o g/10.3389/ psyg.2022.740269
sholihin, M., & a mono, D. (2013). SEM-PLS ANalysis wi h Wa pPLS 3.0. (1s ed.). andi O se .
sohaib, M. (2022). an in es iga ion o epu chase in en ions in he banking indus y: Wha eason do hey e u n?
SAGE Open, 12(1), 215824402110672. h ps://doi.o g/10.1177/21582440211067228
eme ak, M. s., & el-Mans ly, D. (2019). he in luence o goal a ainmen and swi ching cos s on cus ome s’ s aying
in en ions. Jou nal o Re ailing and Consume Se ices, 51, 51–61. h ps://doi.o g/10.1016/j.j e conse .2019.05.020
Van onde , e., & nel, c. B. (2018). Valida ing ela ionship ma ke ing ac o s p edic ing B2B cus ome loyal y owa ds
c op p o ec ion supplie s. Jou nal o Con empo a y Managemen DHET, 15, 224–249.
Wei, k., li, Y., Zha, Y., & Ma, J. (2019). us , isk and ansac ion in en ion in consume - o-consume e-ma ke places.
Indus ial Managemen & Da a Sys ems, 119(2), 331–350. h ps://doi.o g/10.1108/iMDs-10-2017-0489
Wong, k. h., chang, h. h., & Yeh, c. h. (2019). he e ec s o consump ion alues and ela ional bene i s on sma -
phone b and swi ching beha io . In o ma ion Technology & People, 32(1), 217–243. h ps://doi.o g/10.1108/
i P-02-2018-0064
Wong, a., & Zhou, l. (2013). De e minan s and ou comes o ela ionship quali y: a concep ual model and empi ical
in es iga ion. Jou nal o In e na ional Consume Ma ke ing, 18(3), 81–105. h ps://doi.o g/10.1300/J046 18n03_05.
Yuan, c. l., Moon, h., kim, k. h., Wang, s., & Yu, X. (2020). hi d-pa y o ganiza ion endo semen impac s on pe -
cei ed alue and B2B cus ome loyal y. Indus ial Ma ke ing Managemen , 90, 221–230. h ps://doi.o g/10.1016/j.
indma man.2020.07.021
Yuen, k. F., Wang, X., Wong, Y. D., & Zhou, Q. (2018). he e ec o sus ainable shipping p ac ices on shippe s’ loyal y:
he media ing ole o pe cei ed alue, us and ansac ion cos . T anspo a ion Resea ch Pa E: Logis ics and
T anspo a ion Re iew, 116, 123–135. h ps://doi.o g/10.1016/j. e.2018.06.002
Zaune , a., kolle , M., & ha ak, i. (2015). cus ome pe cei ed alue—concep ualiza ion and a enues o u u e
esea ch. Cogen Psychology, 2(1), 1061782. h ps://doi.o g/10.1080/23311908.2015.1061782
Zhao, J.-D., huang, J.-s., & su, s. (2019). he e ec s o us on consume s’ con inuous pu chase in en ions in c2c
social comme ce: a us ans e pe spec i e. Jou nal o Re ailing and Consume Se ices, 50, 42–49. h ps://doi.
o g/10.1016/j.j e conse .2019.04.014
