1

Willingness to Pay for Senior Wellness Center

Kornprom Satraphand* and Supeecha Panichpathom**

Abstract: Although Thailand is a developing country, it is well equipped for medical care. Nowadays, Thai people have a better quality of life and step into senior society, which makes it necessary to study the needs of the elderly in various aspects including their preferences of using wellness center. Past studies have focused on medical therapeutic health care rather than preventive health care. Therefore, it is crucial to study wellness center characteristics preferred by the elderly as well as willingness to pay of each group. Location, staffs, facilities, design, and accessibility are the main senior wellness center attributes extracted from triangulation. Willingness to pay analysis of 471 respondents from 50 to 79 years old shows that recreational center with safety concern design, skillful staffs, located in quality environment, and accessible via public transportation are the most valued characteristics of senior wellness center. There are 3 groups of the respondents: (1) Fit & Cozy Pre-Senior (2) Recreation & Cozy Senior (3) Recreation & Green Pre-Senior. For future research, data collection in different seasons can be useful to test the validity of senior wellness center attributes and levels. Exploring the needs and willingness to pay of LGBTQ elderly and senior consumer behavior in health care services can be valuable information for real estate developers.

Keywords: Conjoint Analysis, Segmentation, Facilities, Staffs, Design

* Graduate student, Master of Science (Real Estate Program), Faculty of Commerce and Accountancy, Thammasat University, kornpromsatraphand@hotmail.com ** Assoc.Prof.Dr. Instructor, Faculty of Commerce and Accountancy, Thammasat University, supeecha@tbs.tu.ac.th

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1. Introduction

According to National Statistical Office of Thailand (2014), Thailand has a population over

67 million people, and 14.9% of which is the elderly. In 2015, Bangkok had about 940,000

seniors living in the city. Thai seniors have a tendency to live alone and prefer social activities

within their community. Overall, Thai people tend to have higher life expectancy with the

average of 75 years (Knodel, Teerawichitchainan, Prachuabmoh, and Pothisiri, 2015). With

advanced technology, medical services and staffs, reasonable service fees, and the supports

from the government, preventive health care business, such as wellness center is gaining an

interest among pre-senior (50-59 years old) and today senior users. They are paying more

attention to their health and focusing on maintaining their healthy lifestyle by using wellness

center (Chen, Liu, and Chang, 2013; Kim and Batra, 2009; Sperazza and Banerjee, 2010,

Sperazza, Dauenhauer, and Banerjee, 2012) Therefore, senior health and wellness is an

interesting business opportunity for real estate developers, and unlike hospitals that have to

operate under strict circumstances, wellness centers are more flexible and can be built around

the needs and the demands of the target users (Davis, Marino, and Davis, 2007).

Wellness, in general, is a harmonization of body, mind, and spirit (Myers, Sweeney, and

Witmer, 2000). For seniors, wellness means focusing on individual growth, being able to use life

experience, building meaningful connection with others, realizing their life purpose (McMahon

and Fleury, 2012) and promoting healthy behaviors in their daily life (Coberley, Rula, and Pope,

2011). Studies also found that leisure activity in wellness center plays an important role in

promoting senior wellness because they help enhancing both physical and psychological

strength of the elderly (Heo and Lee, 2010, Sperazza and Banerjee, 2010, Sperazza et al.,

2012).

In Thailand, wellness center is becoming more popular among both pre-senior and today

seniors. Their main purpose of using the center is to relax and maintain good health

(Kanittinsuttitong, 2015), but wellness center is still relatively new in Thailand and should be

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further studied in terms of preferred settings and services of the center as well as the

preferences of each group because seniors are not homogeneous (Alen, Losada, and Carlos,

2015). Many spas and hospitals are starting to pay attention to wellness trend and trying to

integrate wellness concepts into their products and services to create more value for their

business (Cohen, 2008).

To get an insight of how to successfully build a wellness center to serve potential users,

many health care related business studies used willingness to pay method together with

conjoint analysis and segmentation to identify the preferred combination of the product as well

as potential users. They can also provide valuable information that can be used in real estate

project feasibility study.

2. Literature Review

2.1 Willingness to Pay

According to Breidert, Hahsler, and Reutterer (2006), there are four ways to measure

willingness to pay including market data, field experiments, auction, direct questionnaire and

indirect questionnaire. Each of these methods has different advantages. First, market data, past

data is used to forecast future demand of the market, which is suitable for consumer goods and

products that are already in the market. Second, filed experiment can be divided in to laboratory

and field experiments. They are useful in pricing products and assessing the consumers’

perspectives of products via auction process, which can be used in both laboratory and field

experiments, but for this method, the actual products must be presented in the experiment. Vickery

Auction (Ausubel, 2004; Levin, 2004; Lucking-Reiley, 1999) and The Becker-Gegroot-Marschak

Mechanism (Keller, Segal and Wang, 1993; Wlomert and Eggers, 2016) are the two popular ways to

elicit willingness to pay by using auction. Third, direct questionnaire can be used to gather data

from both customers and experts. It is quick and convenient, but it only works effectively in a small

group of customers or a niche market, such as luxury goods because data acquired from these

customers and experts can be bias toward certain aspects and should not be generalized and

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applied to mass market products (Breidert et al., 2006). Fourth, indirect survey can elicit willingness

to pay when attributes of products and target customers information are presented, and it is useful

when developing new products (Cameron and James, 1987).

Willingness to pay is often used in the studies of real estate and health related products and

services to test the preferences of product combinations (Cookson, 2004; Olsen and Smith, 2001;

Pollinger, 2014; Wang, Zuo, Lin, Ling, Li, Lamoureux, and Zheng, 2015). Preferred method when

collecting data for willingness to pay is indirect survey and analyze the data by using conjoint

analysis because it is time and cost efficient, flexible to different types of product attributes, and

able to estimate at an individual level (Breidert et al., 2006). Although willingness to pay is useful in

many ways, there are some drawbacks that should be taken in considerations. Monetary bias with

price-related attributes and overestimation problems (Cookson, 2003) can be solved by using non-

price attributes to avoid respondents’ bias of choosing the lowest price as the most preferred

attributes (Breidert et al., 2006).

2.2 Conjoint Analysis

Conjoint analysis (CA) is a useful tool in marketing and studying product attributes and

levels (Green and Srinivasan, 1978; Green, 1984; Green and Srinivasan, 1990; Louviere, Flynn, and

Carson, 2010). CA is a measurement of a set of attributes. It tests the reliability and validity of the

obtained data (Green and Srinivasan, 1978). CA is based on Conjoint Measurement (CM) theory,

initiated in 1964 (Luce and Tukey, 1964). CM uses mathematical principles and system behavior,

numbers and algorithms theories and later, began applying the theory to the study of preferences

of consumers and products in 1971 (Green and Rao, 1971). CA is often used to study product

development, pricing, marketing, consumer segmentation and positioning of products. During

1980, there were about 400 commercial product studies using conjoint analysis (Wittink and Cattin,

1989; Cattin and Wittink, 1982; Mahajan and Wind, 1992). With trade off ability of conjoint analysis,

respondents have to use their judgments and choose their preferred product combinations that will

give them the most utility. Conjoint analysis is helpful in many ways including understanding market

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preferences, predicting market choices, developing market strategies, and segmenting the market

effectively (North and Vos, 2002). Thus, conjoint analysis is suitable to use in the study of new

product and service concepts and market segments of each product line with details of the

possible customers (Green, Carroll, and Goldberg, 1981).

According to Vandebroek, Goos, Scarpa, and Vermeulen (2008), there are four methods of

conjoint analysis, which are Rating-based Conjoint, Ranking-based Conjoint, Contingent Valuation

(CV), and Choice-Based Conjoint (CBC). The most common method of conjoint analysis is ranking-

based conjoint analysis. It focuses on the respondents’ acceptance of the combination of product’s

attributes. Ranking-based conjoint analysis is a simple tool to measure preferences. The main

problem of this method is missing rank, which can leads to an incomplete data, so simplifying the

process of data collection is the key to reduce errors of missing rank (Lam, Koning, and Frances,

2010).

Conjoint analysis in health care begins with identifying research question and extracting

attributes and levels from both literature review and triangulation testing. The attributes and levels

are then used to create combinations of products or services to be used in questionnaire. The

questionnaire is pilot-tested and adjusted before the actual data collection. After gathering the

needed information, data is entered into SPSS and statistically analyzed. Lastly, the results are

finalized, presented, and discussed (Bridges, Hauber, Marshall, Lyoyd, Prosser, Regier, Johnson,

and Mauskopf, 2011).

2.3 Segmentation

Segmentation is an important tool in targeting market to design products and services to

meet the needs of consumers in different target groups with different consumption behaviors.

Segmentation effectively helps product developers, marketers, and entrepreneurs to be able to

reach target audience and be consistent with the organization’s goals (Dibb and Simkin, 2010).

According to Alen et al. (2015), demographic data can be effectively used to group respondents

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according to their preferences when choosing wellness center. Boksberger and Laesser (2008)

used demographic data to group respondents and found that pre-senior and seniors have different

consumption behaviors in wellness related products and services, which is consistent with

Sperazza and Banerjee (2010) and Sperazza et al, (2012).

To effectively design products, potential customers’ data must be obtained in various

aspects. For a relatively new product, customer information and their preferences are still vague.

Using hierarchical cluster analysis is a quick and easy way to identify the possible groups of

respondents that are statistically significant as a guideline to be further used in K-Mean cluster

analysis for more details of each of the possible groups (Sebastiani and Peris, 2016). K-Mean

cluster analysis is a simple and useful tool in grouping the respondents. With sufficient information

of the respondents, such as demographic data and preferred combinations of products, unique

characteristic of each group can be identified and explained (Kashwan, 2013; Thiprungsri and

Vasarhelyi, 2011). After identifying the possible groups with hierarchical cluster analysis and giving

meaning to each group, demographic data, such as sex, age, education, and occupation, can be

crosstab with this information to further explain the uniqueness of each group (Satraphand, 2017).

2.4 Senior Wellness Center Attributes and Levels

Senior wellness center attributes can be divided into two main categories: the physical

attributes and the service attributes of the centers (Rasila, Mikkola, and Rasila, 2006). Service-

related attributes like staffs are the feature that adds value to real estate. It differentiates products

within the same sector, and the adjustment can be made prior to the demands of the users while

core attributes like facilities are difficult and almost impossible to change or adjust once it is settled

(Satraphand, 2017). To create different combinations of senior wellness center, five main attributes

and twelve levels were extracted from the literature review as shown in the table 1.

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Table 1: Literature Review of Senior Wellness Center Attributes and Levels

Attributes and Levels

1.

Caca

ce e

t al.,

201

4

2.

Cobe

rley

et a

l., 2

011

3.

Cohe

n, 2

008

4.

Cour

tney

, 200

8

5.

Datti

lo e

t al.,

201

5

6.

Dem

iris e

t al.,

200

8

7.

Felix

et a

l., 2

014

8.

Han

et a

l., 2

015

9.

Lee

and

Grov

es, 2

014

10. L

eitn

er a

nd L

eitn

er, 2

012

11. P

arda

sani

& T

hom

pson

, 201

2

12. P

arda

sani

, 200

4

13. P

ollin

ger,

2014

14. R

asila

et a

l., 2

006

15. S

aari

and

Tans

kane

n, 2

011

16. S

hend

ell e

t al.,

201

1

17. S

karu

pski

and

Pelk

owsk

i, 20

03

18. S

pera

zza

and

Bane

rjee,

201

0

19. S

pera

zza

et a

l., 2

012

20. T

owns

hend

and

Lak

e, 2

011

21. T

urne

r, 20

04

22. W

right

et a

l., 2

014

1. Location X X X X X X X

1.1 Quality environment X X X X

1.2 In community X X X X

1.3 In suburb X X X X

2. Staffs X X X X X X X

2.1 Friendly X X X

2.2 Certified X X

3. Facilities X X X X X X X X X X

3.1 Fitness Center X

3.2 Recreational Center X X X X X X

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Table 1: Literature Review of Senior Wellness Center Attributes and Levels (Continue)

Attributes and Levels

1.

Caca

ce e

t al.,

201

4

2.

Cobe

rley

et a

l., 2

011

3.

Cohe

n, 2

008

4.

Cour

tney

, 200

8

5.

Datti

lo e

t al.,

201

5

6.

Dem

iris e

t al.,

200

8

7.

Felix

et a

l., 2

014

8.

Han

et a

l., 2

015

9.

Lee

and

Grov

es, 2

014

10. L

eitn

er a

nd L

eitn

er, 2

012

11. P

arda

sani

& T

hom

pson

, 201

2

12. P

arda

sani

, 200

4

13. P

ollin

ger,

2014

14. R

asila

et a

l., 2

006

15. S

aari

and

Tans

kane

n, 2

011

16. S

hend

ell e

t al.,

201

1

17. S

karu

pski

and

Pelk

owsk

i, 20

03

18. S

pera

zza

and

Bane

rjee,

201

0

19. S

pera

zza

et a

l., 2

012

20. T

owns

hend

and

Lak

e, 2

011

21. T

urne

r, 20

04

22. W

right

et a

l., 2

014

4. Design X X X X X X 4.1 Safety concern X X 4.2 Privacy concern X X

5. Accessibility X X X X X X 5.1 Public Transportation X X 5.2 By Appointment X 5.3 Shuttle Service X X

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3. Data and Methodology

3.1 Data

Respondents from the age of 50 to 79 years old in Bangkok, Thailand who have used

services or products related to health were asked to answer screening health questions, such as

smoking and dieting habits because according to Kim and Batra (2009), those who have healthy

lifestyles are more likely to become the users of wellness center than any other groups. The

respondents were then asked to rank their preferred combinations of wellness center, and rate their

willingness to pay for each combination.

3.2 Methodology

3.2.1 Attributes and Level extraction

After the triangulation testing, attributes and levels were rated and rearranged according to

their importance values with the additional levels from the in-depth interviews of 17 people.

Attributes and levels used in this study are shown in the table 2

Table 2: Attributes and Levels of Senior Wellness Center

Attributes Levels 1. Facilities 1.1 Fitness Center

1.2 Recreational Center 1.3 Open-Space Fitness Center*

2. Staffs 2.1 Friendly 2.2 Certified 2.3 Skillful*

3. Design 3.1 Safety Concern 3.2 Privacy Concern 3.3 Natural and Green setting*

Note: The level with "*" on the back is the level extracted from in-depth interviews and triangulation.

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Table 2: Attributes and Levels of Senior Wellness Center (Continue)

Attributes Levels 4. Location 4.1 Quality Environment

4.2 In Suburb 4.3 Within 1 hour drive*

5. Accessibility 5.1 Public Transportation 5.2 By Appointment

5.3 Shuttle Service Note: The level with "*" on the back is the level extracted from in-depth interviews and triangulation.

3.2.2 Pilot test of 30 samples and take in their suggestions for improving the questionnaire

before the actual survey.

3.2.3 Collect data using both paper and online questionnaire forms.

4. Analytical Results

Table 3: Demographic information of 471 respondents

Demographic Information of 471 Respondents Sex Age Education Occupation

Male = 165 Female = 274 LGBTQ = 32

Pre-Senior = 238 Senior (60-69 years old) = 157 Seniors (70-75) years old = 76

Undergraduate = 14 Bachelor’s Degree = 230 Master’s Degree = 204 Doctor’s Degree = 23

Business Owner = 122 Office Worker = 148 Freelance = 100 Retired = 54 Other = 47

Using SPSS, Discrete model, the respondents were asked to rank 20 sets of senior wellness center obtained from the orthogonal design with 4 holdouts based on their preferences. The information was entered into SPSS and analyzed. The result is shown in table 4.

After ranking the preferred combinations, respondents were asked to rate their willingness to pay for each combination of wellness center. The highest willingness to pay combination is shown in the table 5.

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Table 4: Utility Estimate and Importance Value of Senior Wellness Center

Model Attribute Level Utility Estimate

Importance Value

Discrete Facilities Fitness Center (F1) Recreational Center (F2) Open-Space Fitness Center* (F3)

0.109 1.289 -1.398

0.372 0.436 0.436

Discrete Staffs Friendly (S1) Certified (S2) Skillful* (S3)

0.179 -1.279 1.100

0.372 0.436 0.436

Discrete Design Safety Concern (D1) Privacy Concern (D2) Natural and Green setting* (D3)

0.618 -1.342 0.724

0.372 0.436 0.436

Discrete Location Quality Environment (L1) In Suburb (L2) Within 1 hour drive* (L3)

0.423 0.453 -0.876

0.372 0.436 0.436

Discrete Accessibility Public Transportation (A1) By Appointment (A2) Shuttle Service (A3)

0.581 0.142 -0.723

0.372 0.436 0.436

Constant 7.982 Pearson’s R 0.941

Kendall’s tau 0.812 Kendall’s for holdouts 0.333

Table 5: Combination of Senior Wellness Center with the Highest Willingness to Pay

Senior Wellness Center Combination

Facility = Recreational Center Staff = Skillful Design = Safety Concern Location = Quality Environment Accessibility = Public Transportation

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Using Hierarchical Cluster Analysis to find the appropriate number of clusters, and then

grouped by K-Means Cluster Analysis to find out different characteristics and preferences of the

respondents in each group. The groups were then crosstabs for the demographic characteristics of

each group as shown in the table 6.

Table 6: Groups of seniors, their characteristics and demographic information

Group Characteristics Demographic

Fit & Cozy Pre-Senior

Facility: Fitness Center Staff: Skillful Design: Natural and Green setting Location: In Suburb Accessibility: Public Transportation

Sex: Female Age: Pre-Seniors Education: Bachelor’s Degree Occupation: Office Worker

Recreation & Cozy Senior

Facility: Recreational Center Staff: Friendly Design: Privacy Concern Location: Quality Environment Accessibility: By Appointment

Sex: Female Age: Seniors (60-69 years old) Education: Bachelor’s Degree Occupation: Retired

Recreation & Green Pre-

Senior

Facility: Recreational Center Staff: Skillful Design: Natural and Green setting Location: In Suburb Accessibility: By Appointment

Sex: Female Age: Pre-Senior Education: Bachelor’s Degree Occupation: Office Worker

5. Conclusion

From the literature review and triangulation testing, there are three main types of wellness

center with different combinations. Recreational center combination as shown in the table 5 gives

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the highest total utility. For willingness to pay analysis, recreational center combination has the

highest score comparing to other types of the center. The finding is consistent with Cohen (2008),

Dattilo et al. (2015), Pardasani and Thompson (2012), Sperazza and Banerjee (2010) and Sperazza

et al, (2012). This study also found that recreational center is rated as the most preferred type of

wellness center, and the majority of the respondents is female similar to the study of Dattilo et al.

(2015) and Sperazza and Banerjee (2010). Based on these findings, we can conclude that female

tend to be more interested in health and wellness products and services, especially, recreational

center (Satraphand, Panichpathom, and Metapirak, 2017).

5 Limitation

With limited time and financial resources, the data collection is limited to certain group of

people (middle-class and well-educated seniors), thus the finding cannot be generalized and

applied to the majority of Thai seniors because most Thai seniors are undergraduate with low

income. For this reason, wellness center in Thailand is still a niche product.

6 Suggestion

For future research, data collection in different seasons can be useful to test the validity of

senior wellness center attributes and levels because the data collection process was in the summer

in Thailand. The weather was extremely hot and humid making an open-space fitness center the

least preferable option. From 471 respondents, there were 32 seniors who are LGBTQ with high

disposable income. Therefore, Exploring the needs and willingness to pay of LGBT seniors can be

an interesting opportunity for real estate developers. Exploring the needs and willingness to pay of

LGBTQ elderly, technology features in wellness center, proper membership fees, and senior

consumer behavior in health care services can also be valuable information for real estate

developers. Finally, during the literature review, there were only few senior consumer behavior

studies relating to health and wellness, therefore, more research on this topic can be very useful for

future studies.

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