Rehabilitation market segmentation and positioning of rehabilitation providers

Ting, Horace;Fitzgerald, Maureen H

Journal of Rehabilitation; Apr/May/Jun 1996; 62, 2; Research Library pg. 36
Rehabilitation Populations

Rehabilitation Market Segmentation and Positioning of

Rehabilitation Providers
Horace Ting Maureen H. Fitzgerald
University of Sydney
The existence of segments within a larger health care market is evident from the literature. However,
there is little information available on the heterogeneous nature of the rehabilitation market and the
diverse needs of the consumers. The authors conducted a segmentation study on the rehabilitation
market in Hong Kong and used socio-demographic and injury variables to segment the market.
Analyses of variance were used to test the differences between the segments. The results showed that
the rehabilitation market could be segmented using the variables: age, education, duration of sick leave,
duration of injury, and occupation. Important rehabilitation service attributes for different segments of
the market were identified. The authors described different ways of applying the findings to improve the
competitiveness of rehabilitation providers.

W ith a call for a market-oriented approach to the provision of rehabilitation services (Patterson & Marks, 1992; Seekins, Mathews,
Fawcett, Jones & Budde, 1988), rehabilitation providers need to recognize the diverse needs of consumers, and the heterogeneous nature of the
rehabilitation market (Smith, 1956). They must be able to categorize consumers according to some of their definable characteristics and to tailor
the market program for each category (May, 1985). This procedure is called market segmentation which is defined as “the act of dividing a
market into distinct and meaningful groups of consumers” (Kotler & Clarke, 1987, p.233).
The basic proposition behind market segmentation is that within a total rehabilitation market there may be groups of consumers with similar
wants and needs but whose wants and needs are different from other groups (Kotler, 1988). This gives rise to the notion that these smaller
markets are internally homogeneous but externally heterogeneous. An analogy might be the existence of different kinds of fish in a habitat. Each
type feeds on different nourishments. Some like smaller fish, some like worms, and others like shrimp.
Market segmentation involves three steps (Kotler, 1988). The first step is to identify segmentation variables, segment the market and
develop profiles of the resulting segments. Using the same analogy, the fish can be categorized according to different characteristics, such as;
type, feeding habit, size and locality. The second step involves the evaluation of the attractiveness of each segment and the selection of the target
segment. The third step, called positioning, involves identifying and selecting possible promotional concepts for each target segment, and then
developing and signalling the chosen promotional concept. It aims at distinguishing a service from competitive offerings in the mind of the
consumer (Lovelock, 1987; Ries & Trout, 1981). Using the analogy again, some fishermen may want to catch all the fish they can. Others may
only want to catch a specific kind of fish. Fishermen whose concern is mainly the quantity of fish caught may use bait that appeals to the majority
of fish within the habitat. Those who want to catch only specific kinds of fish need to use bait that appeals to that fish. They also need to pay
attention to other habits.
Horace Ting, The University of Sydney, Faculty of Health Sciences, RO. Box 170, Lidcombe NSW 2141, Australia.
Journal of Rehabilitation
A iti-i I i \/f / i v / f m i / j / 0 0 f\
36
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 In the United States, the diffusion of the market segmentation concept in the health care market has been slow since its inception in the early
1960’s. In the 1980’s, the adoption of the concept has been stimulated by an increasingly competitive and rapidly changing environment (Finn &
Lamb, 1986). An increase in health care segmentation studies reported in the literature throughout the 1980’s reflects this trend (e.g., Berkowitz
& Flexner, 1980-81; Boscarino & Steiber, 1982; Finn & Lamb, 1986). In a relatively recent study by Woodside, Nielsen, Walters and Muller
(1988), the results of a national segmentation study confirm that consumers with preferences toward specific hospitals can be segmented into a
few distinct groups, and each group or segment has a unique demographic profile.
The value of market segmentation and positioning as marketing tools has been reported in the context of both consumer goods and services
(Hooley, 1978; Porter, 1985; Smith & Clark, 1990). Segmentation studies specific to the health care market have also been reported. Smith and
Clark (1990) concluded from their study of images for hospitals and service centers that the traditional focus of health care management on
undifferentiated markets and services is inadequate to reflect consumer perceptions within one health care market. McAlexander, Becker and
Kaldenberg (1993) studied the impact of positioning strategy on financial performance of 264 general dentists in private practice and the results
showed a significant different between positioned dentists and unpositioned dentists in their earnings. These findings further strengthen the
argument for the adoption of positioning strategy by rehabilitation providers.
Purpose and objectives of study
However, most of these segmentation and positioning studies are context specific and the generalization of their findings to the
understanding of rehabilitation consumers is restricted. In view of the small amount of literature available on segmentation of the rehabilitation
market and on positioning of rehabilitation providers, the present study aimed at gaining a fuller understanding of the rehabilitation service
market in Hong Kong, a new and somewhat different context. It was also a response to macroenvironmental changes in this context and their
impacts on the competitiveness of service providers within the rehabilitation market.
For example, during the past decade, events such as the Joint Declaration between the Thatcher Government and the Chinese Government
on the handing over of the sovereignty power of Hong Kong to China in 1997 and the Tiananmen Square massacre, have initiated and added
momentum to a democratic movement in Hong Kong. People are increasingly aware of their rights as a person, a citizen, a consumer, and above
all as an employee. In large organizations, a new breed of union leaders is beginning to emerge to serve the interests of their members.
In addition, as blue collar workers represent a major stratum of the society, a few political groups have been formed to represent the
interests of workers. Occupational health and rehabilitation issues that rarely caught the attention of appointed legislative councillors in the past
have now become major concerns.
With the advancement of telecommunication technology, gaps in occupational health and safety standards between developed and
developing countries are also closing up. Developments in protection of workers’ health overseas and easy access to the information through
advances in telecommunication technology have increased interested political groups’ negotiation power in lobbying for changes and
improvements within the occupational health and rehabilitation system.
This is fuelled by a tremendous economic growth that has made Hong Kong the second highest in per capita income in Last Asia. Rogers
(1968) suggested surplus economic resources as an important prerequisite for the development of social services.
In general, there have been increases in awareness and know'ledge of occupational health and rehabilitation matters by legislative
councillors. District Board members, labour union members, and above all employees. Changes in attitudes towards occupational rehabilitation
services have created opportunities to expand services in this area.
Thus, the specific objectives for this study were a) to understand different consumers’ needs and wants within this rehabilitation market; b)
to rationalize policies for existing services; and c) to position ranges of service varieties, that is the development and marketing of sendee
offerings to specific market segments. The explicit design of sendees to satisfy the needs of particular market segments is central to the
segmentation approach. The setting of the above objectives is based on three propositions (Engel, Fiorillo & Cayley, 1972). First, consumers
within the rehabilitation market differ from each other in one or more respects. Second, differences in consumers are related to differences in
market demand and third, segments can be isolated within the market.
The study consisted of three parts: the first part involved the development of a set of service attributes and attribute factors (Ting, 1995); the
second part involved the identification of different segments based on socio-demographic and injury variables; and the last part involved the
identification of perceptions and preferences of the services provided by two major groups of rehabilitation providers and the Hong Kong
Workers’ Health Center
(WHC). 1 This paper presents the findings of the second part of this study and their implications for rehabilitation service providers.
Method
There are two general prototypical segmentation research approaches: a priori segmentation and a clustering-based segmentation (Wind,
1978). In a priori segmentation, the researcher chooses in advance some segment-defining variables such as product purchase, loyalty, or
customer type. Once respondents
April! May!June 1996
Journal of Rehabififation
* The Hong Kong Workers’ Health Center is a non-profit making organization with its major activities being the promotion of industrial health concepts through community-oriented
education programs. In 1991, the Center had secured a donation amounted to US $150,000 from the Royal Hong Kong Jockey Club Donation Foundation to finance a three-year
project involving the setting up a rehabilitation serv ice for injured workers. The findings of the study were used to assist the positioning of this new service in the local rehabilitation
market.

37

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 Table 1: Classification of segmentation variables

Consumer characteristics

General Situation specific

Consumption patterns; brand loyalty,

Objective measure
Demographic factors (age, stage in life buying situations
cycle, sex); socioeconomic factors

Inferred measure Personality traits; life style Attitudes; perceptions & preference |
(Source : Frank, Massy & Wind, 1972)
Table 2: Twenty-six attribute items and eight attribute factors

No. Attribute item No. Attribute item

1 location 14 doctors are attentive to you

2 cost of service 15 competence of therapists

3 waiting time 16 therapists explain procedures that concern you

4 availability of all rehabilitation services 17 therapists examine you thoroughly

5 availability of service on weekends and eveninqs 18 therapists treat you as an individual

6 provide rehabilitation information 19 therapists are attentive to you

7 up to date equipment 20 ability to see doctors of choice

8 patients exercise facilities 21 quality of care

9 modernly designed rehabilitation facility 22 caring attitude

10 doctors examine you thoroughly 23 efficiency of service

11 competence of doctors 24 ability to see therapists of choice

12 doctors explain procedures that concern you 25 follow-up

13 therapists treat you as an individual 26 staff treat you as an individual

No. Attribute factor No. Attribute factor

1 Medical staff care for you 5 Doctors explain procedure and provide

information that concern you

2 Modernly designed facility and advance equipment 6 Doctors examine and treat you effectively

3 Ability to see medical staff of choice 7 Waiting time

4 Competence of therapists 8 Service provided is convenient to use

Journal of Rehabilitation April!May!June 1996
have been segmented on the selected criterion, the segments can then be further examined regarding their differences on other characteristics, for
example, attitudes toward different rehabilitation providers (Hooley, 1978). In a clustering-based segmentation, respondents are clustered
according to the similarity of their multivariate profiles on a set of characteristics. Benefit, need and attitude segmentation are examples of this
type of approach. Once formed, segments can be further examined for differences in other characteristics (e.g., Finn & Lamb, 1986; Woodside,
Nielsen, Walters & Muller, 1988). The number of segments derived is determined by the clustering process and not specified a priori.
The health care market can be segmented using different bases, including socio-economic variables, psychographic profile, geography,
volume of usage and benefit sought (Finn & Lamb, 1986). Some bases can also be used to segment the rehabilitation market. Table 1 presents a
classification system of segmentation bases suggested by Frank, Massy and Wind (1972). The usefulness of any variable as a basis for
segmentation will depend on the objectives of a particular study. For example, if a rehabilitation provider is primarily concerned with selecting
media for an advertising campaign, psychographic profile and benefits sought are particularly useful bases for segmentation. For determining
the effect of an imminent price increase on sales, however, price sensitivity is more useful. Hooley (1978) gave a comprehensive account of the
usefulness of different segmentation bases (Vol. 1, p.
116-127). The present study adopted the a priori-based segmentation approach. Socio-demographic and injury variables were used as a basis for
segmentation because they are easily measured, and can be directly related to media selection for promotion purposes.
Identifying market segments
Subjects
A purposeful sample was selected which consisted of 49 injured workers attending a medical assessment in two hospitals, one on the Hong
Kong Island and the other on the Kowloon Peninsula. The workers, while waiting to be assessed, were approached and invited to participate in
the survey. They were selected on the basis that they had previous experience in using at least one rehabilitation facility in the past six months.
Rehabilitation facility is defined operationally as a premises whereby treatments of work injury or occupational disease were delivered by at
least one rehabilitation practitioner beside a medical practitioner. This ensures that all respondents were reasonably familiar with rehabilitation
facilities.
Procedure
A survey questionnaire was developed which consisted of three sections. The first section was composed of questions relating to
socio-demographic and injury characteristics with individual questions on: age, sex, marital status, family income, occupation, education level,
home ownership, duration and kind of injury, resumption of duties, and duration of sick leave. The second section consisted of questions
identifying the types of rehabilitation facility visited by the respondents. The last section contained an attitudes checklist which consisted of 26
attribute items. These 26 attribute items are listed in Table 2. The items were later reduced using the Principal Components Analysis Technique
into eight attribute factors. The eight attribute factor labels are “MEDICAL STAFF CARE FOR
YOU 2 (factor 1)”, “MODERNLY DESIGNED FACILITY AND ADVANCE EQUIPMENT (factor 2)”, “ABILITY TO SEE MEDICAL

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 STAFF OF CHOICE (factor 3)”, “COMPETENCE OF THERAPISTS (factor 4)”, “DOCTORS EXPLAIN PROCEDURE AND PROVIDE
INFORMATION THAT CONCERN YOU (factor 5), “DOCTORS EXAMINE AND TREAT YOU EFFECTIVELY (factor 6)”, “WAITING
TIME (factor 7)”, and
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^ Attribute factors are presented in upper case and attribute items are in lowercase.

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 Table 3: Frequency distribution of the sub-groups, and their most important attribute(s) and attribute faotor(s)

Variable Sub-group Most important attribute factorfs)

Frequency (Percentage [*/k]) Most important attribute(s) (rating)5 (rating)

Age <25 8(16 3) 10,11(1.38) 6(1 56)

26-35 11(22.4) 14(1.55) 4(1-73)

36-45 21(42.9) 23(1 29) 6(1.58)

>46 9(18.4) 21(1.33) 10.68)

Sei Male 45(91.8) 11(1 49) 6(1 68)

Female 4(8.2) 12,15,16(1 25) 4(133)

Marital status single 14(28.6) 100.5) 6(1.68)

Married 35(71.4) 15(1.43) 4(171)

Family income <15,000 43(87.8) 7(1 49) «|7°>

15,001-25,000 6(122) 1.23(1 167) 4(1.44)

Occupation 14(28.6) 15(1.29) 4(1.55)

Supervisory/ Skilled /Professional /Others

Labouring 23(469) 15,17(1.49) 4(1 64)

Techrucal/clencal 12(24.5) 7,11(1.33) 6(1 67)

Education level Primary/Others 23(46.9) 11(1 39) 60 65)

Junior High School 16(32.7) 3,7(1.31) 7(150) ___________

Senior High School 10(20.4) 15.16(1.20) 4(1.27)

Yes 14(28.6) 15(1 36) 4(145)

Home ownership

No 35(71 4) 11(1 57) 6(171)

Kind of injury Back 5(10.2) 3,5.7,10(1.20) ___________ Itlii _____________

Upper limb 20(40 8) 11(1 40) «169)

Lower limb 10(20 4) 7(14) 10 65)

Multiple /Others 14(28.5) 11.12,14.23(1 57) 5,6(1 68)

Duration of injury 6 - 9 months 22(44.9) 15(1.45) 4(1 70)

10-15 months 18(36 7) 15(1.44) __________ £!“) _____________

> 15 months 9(18.4) 10,13(1.56) 5(1.72)

Resumption of Yes 45(91.8) 15(1.49) 6(1.68)

duties
No 4(82) 11,14,17,18(1.75) 4(192)

Sick leave < 30 days 14(28.6) 7,11(1 29) 6(135)

31 - 90davs 17(34 I / 15(1.24) 4(1.40)

91 - 365 days 13(26.5) 10,15,17,23(1.62) 6071) ___________

> 366 davs 5(10.2) 11,12(1 60) 5(1.70)

5 The attributes and attributes factors are listed by number in Table 2

“SERVICE PROVIDED IS CONVENIENT TO USE (factor 8)” (Table 2). The details of the development of the 26 attribute items and the 8
factors were reported in Ting (1995). A Likert summat- ed rating was used to measure the respondents’ importance ratings along the attributes
identified. It required the respondents to rate each item by indicating whether s/he considered it being 1) very important, 2) important, 3) don’t
know, 4) unimportant, and 5) very unimportant in determining his/her preferences toward a particular rehabilitation facility visited. The smaller
the rating, the more important the attribute.
A pilot study which involved ten injured workers attending a medical assessment in a regional Hospital on the Hong Kong Island, was
conducted to test the practicability and communicability of the questionnaire. A follow-up discussion was held to review the questionnaire. Tw'o
points were concluded from the pilot study. First, the respondents had difficulties in understanding the concept of attitude in the attitude
question: “How important are each of the following factors in determining your attitudes toward the rehabilitation facilities visited?” Second, the
respondents encountered difficulties in understanding the attribute items. Subsequently, two aspects of the questionnaire were modified. First,
the doubtful question was re-phrased to: “How important are each of the following factors in determining your choice of rehabilitation
facilities?”, and second, the attitude checklist was changed into a set of attribute statements.
Results
Frequency distributions of the socio-demographic and the injury variables of the 49 respondents are presented in Table 3. The sample
consisted predominantly of males (N=45) ranging in age from 17 to 61 years. Thirty-five out of 49 respondents were married and 14 owned their
homes. All received at least a primary education, 16 completed junior high school and 10 of them completed senior high school. Their
occupations varied from unskilled labouring to professional jobs. Most of them earned less
than HK$15,00(P a month except six who earned between HK$ 15,000 and HK$25,000. All of them had sustained physical injuries: 5 of them
a back injury, 20 an upper limb injury, 10 a lower limb injury and 14 had multiple or other injuries. The most recent injury was 6 months old and
the most distant one was 45 months from the date of the survey. Forty of them sustained injury less than 15 months ago. Out of the 49 respon-
dents, 45 have re-sumed either full or light duties. The number of sick days taken also varied greatly from not having a sick day off to having
almost three years of sick leave.
The mean importance ratings of the attributes as w'ell as the attribute factors of each sub-group of the socio-demographic and injury
variables were computed. The mean importance ratings of the eight attribute factors were computed by averaging the mean importance ratings

39

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 of those attributes included in the factor. The most important attribute/s) and attribute factor(s) of each sub-group are presented in Table 3.
Differences in variables’ group distributions were examined by Crosstabs and chi-square analyses. There were no significant differences among
distributions
of sub-groups between the variables age^, occupation, education level, injury duration and sick leave. However, it w'as found that there was a
higher proportion of older age consumers as well as better educated consumers who owned their home. The family income variable was not used
in the analysis because of a very small entry in one of the two sub-groups.
Current exchange rate is US$1 to HKS7.S.
^ Due to small entry in some of the cells of this variable required for Chi-square analysis, the four age groups were combined to form two age groups, <35 and >36 respectively.
AprillMaylJune 1996 Journal of Rehabilitation

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 bilitation market along prespecified dimensions.
Table 4: Summary of probabilities of ANOVA of the means of the attribute importance ratings between subgroups of those variables showing significant differences

Attribute Age Occupation Education Duration of Duration of

Family Home
income ownership injury Type of Injury leave

1 .880 .028* .283 .667 1.00 .127 .995 .130

2 .664 .531 .490 .429 .436 .411 .321 .931

3 .306 .296 .928 .038* .777 .879 .310 .848

4 .234 .954 .545 .851 .781 .442 .893 .381

5 .193 .447 .257 .158 .700 .860 .020* .015*

6 .978 .674 .859 .791 .478 .692 .363 .266

7 .145 .009** .115 .203 .913 .657 .167 .364

8 .533 .840 .436 .228 .886 .705 .797 .711

9 306 .867 .467 .819 .790 .031* 868 .105

10 .022* .254 .852 .528 .751 .781 .793 .090

11 .813 .447 .290 .313 1.00 .941 .522 .725

12 .783 .564 .395 .771 .670 .876 .690 .850

13 .937 208 .421 .587 .131 .521 .253 .463

14 .930 .211 .558 .028* .958 469 .951 .144

15 .784 .908 .051 .133 .191 .220 .999 .100

16 .945 .053 .200 .004** .044* .844 .950 .071

17 .804 .530 .047* .341 .072 .852 .704 .045*

18 484 .715 .111 .455 .114 .202 .618 .762

19 .130 .272 .031* .144 .001*** .689 806 .788

20 .022* .076 839 .984 .271 .029* .407 .476

21 .001 •*• .938 .053 .040* 1.00 .118 .992 .781

22 .206 .670 .489 .482 .125 .958 783 .513

23 .052 .112 .914 .720 .242 .463 .824 .697

24 .01 r .303 .876 .527 .521 .074 .614 796

25 .875 .877 .680 .825 .014* .324 .618 .151

.517 .742 .906 .804 .369 498
26 .218 .818
\*P= 0.05; **p = 0.01; ~*p = 0.001)
In Tables 4 and 5, cells marked by an asterisk(s) indicate a significant difference in the population means. It does not, however, pinpoint
where the differences are. The Scheffe’ test, a multiple comparison test for pairwise comparisons of means, was used in determining which
means were different between the sub-groups on a particular variable. The results are presented in Table 6.
Age
There were significant differences between sample means for the different age groups on four attributes and one attribute factor. For the
youngest age group (17-25 years), the attributes “doctors examine you thoroughly” and “competence of doctors” were the most important in
determining preference for a rehabilitation facility. For the oldest group (46+), it was “quality of care.” The competence of the therapist was
most important for the 26-35 year olds, and efficiency of service was most important for those 36-45 years of age. Factor 3, “ABILITY TO SEE
MEDICAL STAFF OF CHOICE,” shows an interesting pattern with the two middle age groups rating the factor as more important than either
the youngest or oldest group.

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 Analysis of variance was applied to test the differences in the population means of the sub-groups for each variable both at the attribute and the
attribute factor level. The results, which are presented in Table 4 and 5, indicated that the population means of the sub-groups along 14 attribute
dimensions and 4 attribute factor dimensions were unequal. Those attributes included “location,” “waiting time,”
“availability of service on weekends and evenings,” “up to date equipment,” “modemly designed rehabilitation facility,” “doctors examine you
thoroughly,” “doctors are attentive to you,” “therapists explain procedures that concern you,” “therapists examine you thoroughly,” “therapists are
attentive to you,” “ability to see doctors of choice,” “quality of care,” “ability to see therapists of choice” and “follow-up”.
Those attribute factors included “MEDICAL STAFF CARE FOR YOU.” “ABILITY TO SEE MEDICAL STAFF OF CHOICE,” “COMPETENCE OF
THERAPISTS” and “WAITING TIME”. All variables except “sex” and “marital status” have shown some success in segmenting the reha
Education

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 Education was significant in terms of four attributes and two attribute factors. Those with a senior high school education not only differed from the
others on the attribute “therapists explain procedures of concern,” but they rated this item as one of the two most important determinants for preference.
Their rating on the factor “COMPE-
Table 5: Summary of probabilities of ANOVA of the means of the attribute factor importance ratings between sub-groups of those variables showing significant differences
1 Medical staff care for you
2 Modemly designed facility and
advanced equipment
3 Ability to see medical staff of
choice
4 Competence of therapists
5 Doctors explain procedure and
provide information that concern you
6 Doctors examine and treat you
effectively
8 Service provided is convenient to use
Educatio
Occupatio
Home
ownership
Duration of
Duration of leave
Journal of Rehabilitation
April! May!June 1996

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 Table 6: Results of the Scheffe' tests for segmentation variables at both the attribute and attribute factor level
Variable Sub-group
Mean importance rating of attribute/attribute factor

Attribute 10 Attribute 21 Attribute Attribute Attribute

20 24 factor 3
Age
17-25 1.375 2.750* 3.250 3.625 3.438

26-35 1.727 1.636 2.182 2.273 2.227

36-45 1.381 1.857 2.191 2.952 2.571

46+ 2.333* 1.333 3.222 3.667 3.444

Variable Sub-group Attribute 17 Attribute 19 At tribute facto 4

Occupation
Supervisory/skilled/ 1.643 1.929 1.578
professional

Labouring 1.478 1.565 1.638

Technical/clerical 2.167* 2.333* 2.139*

Variable Sub-group Attribute 3 Attribute 14 Attribute Attribute 21

16
Education
Primary 2.304 1.435 2.250* 1.609

Secondary 1.500 2.000 2.130* 2.250

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 High 2.400 1.600 1.200 1.800

Sub-qroup Attribute factor 4 At tribute factor 7

Primary 1.782 1.739

Secondary 1.958* 1.313

1.267 1.700

Variable Sub-qroup Attribute 9 Attributes 20 Attribute factor 3

Duration of injury
6-9 months 1.818 2.955* 3.205*

10-15 months 2.000 2.000 2.361

16-31 months 2.779* 2.667 2.667

Variable Sub-qroup Attribute 5 Attribute 17 Attribute factor 4

Duration of sick
leave 0-30 days 1.571 2.143* 2.000

31-90 days .529 1.353 1.392

91-365 days 2.615 1.615 1.745

366 days + 1.600 1.800 2.133

Variable Sub-group Attribute 16 Attribute 19 Attribute Attribute Attribute

25 factor 1 factor 4

Home Yes 1.571 1.357 1.357 1.806 1.452

ownership
No 2.143* 2.057* 1.857* 20192* 1848*

C p = 0.05)
TENCE OF THERAPISTS” also came out as the most important determinant factor. Although the differences are not statistically significant, the
attribute and factor associated with waiting tended to be more important for those w ith a junior high school education than the others. In fact,
waiting was one of the two most important attributes (the other was up-to-date equipment) and the most important factor for this group. The
group with a primary education rated “DOCTORS EXAMINE AND TREAT YOU EFFECTIVELY” as the most important determinant factor.
Duration of injury
When duration of injury was used as the primary variable there were significant differences in the between sample means on two attributes
and one factor. With an increase in the time since injury there is a decrease in the importance of the appearance of the facility in terms of
modernity. On the other hand, the findings on the attribute dealing with choice of doctor and the factor on ability to choose medical staff suggest
that those with the shortest period since injury are the least concerned about being able to choose who cares for them.
Duration of sick leave
There were significant between group means for two attributes and one factor when duration of sick leave was considered. The attribute
“availability of services on weekends and evenings” seems more important for those with the shortest and longest periods of sick leave. Those
with the shortest period of leave are more concerned than the others in regard to the attribute dealing with the thoroughness of their examination.
Competency was more important for those in the intermediate length of leave categories, but perceived availability of sendees was less
important. Therefore, not only is the length of time since injury important but so is the length of leave, but different issues seem to become
involved.
Occupation
When occupation was considered there were significant between group differences on two attributes (“therapists examine you thoroughly”
and “therapists are attentive to you”) and the factor (“COMPETENCE ” OF THERAPISTS”) for which they are key components. The
technical/clerical group rated these attributes and attribute factor related to therapists as significantly less important than the other two. In terms
of the ratings for individual items, both the supervisory/skilled/ professional group and the labourer group rated the attribute, “competence of
therapists” and the factor of the same name as most important. The highest rated attributes for the technical/clerical group were “up to date
equipment” and “competence of doctors,” and the highest rated factor was “DOCTORS EXAMINE AND TREAT YOU EFFECTIVELY”.
Thus the technical/clerical group’s orientation tends to be towards doctors and technology or at least the appearance that the facility is up to date
in terms of technology while the other groups are more oriented towards attributes of the therapist.
Income and home ownership
ApriliMaylJune 1996
Journal of Rehabilitation
Two other socio-demographic variables, income and home ownership, are worthy of note. Both are associated with standard economic
indicators. In terms of family income, those in the highest income category appear to place greater emphasis on the attribute “up to date
equipment” than those in the lower income category. With home ownership there w'ere three significant attributes. All three are concerned with
quality of interaction variables (“therapists explain procedures that concern you,” “ther-
apists are attentive to you,” and “follow-up”). There were significant differences between group means on two attribute factors: “MEDICAL
STAFF CARE FOR YOU” and “COMPETENCE OF THERAPISTS”. Thus those who own their own homes are more concerned about the
competence of therapists and their caring attitude than those who live in public dwellings. This reflects the attitudes of the older as well as the
better educated consumers in forming preference for rehabilitation providers. This is consistent with the findings that a higher proportion of
older and better educated consumers own their own homes.
Kind of injury and resumption of duties
Neither kind of injury nor whether or not the person had resumed their duties provided discriminatory information that was useful in this
analysis. It is interesting, however, that each subgroup within this category had a different highest rated attribute, but the differences were not

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 significant.
Discussion
The analyses of all the socio-demographic and injury related variables in terms of attributes commonly associated with rehabilitation
services provide an interesting portrait of this sample, but the only significant segmenting variables are: age, education, duration of sick leave,
duration of injury, and occupation. Knowledge of the attributes and factors associated with each subgroup in the sample provides information
which could allow advantageous market positioning. Thus, the findings of this study reinforce the idea that socio-demographic and injury
variables can be used as a segmentation basis for rehabilitation markets.
Segmenting bv age group
The rehabilitation market can be segmented by different age groups. More mature consumers (46+) seem to highly value the quality of care
received from rehabilitation staff. They are not as concerned with the doctor’s skill in examination nor are they overly concerned about choosing
their own therapist when compared to younger consumers. On the other hand, younger consumers (17-25 and 26-35 year olds) seem to highly
value evidence of competency in the staff, especially skill in examination. Consumers between 36-45 are most concerned about physical
equipment and the efficiency of the rehabilitation facility. This suggests an age related trend that moves from an emphasis on the technical
aspects of rehabilitation facilities to a more nebulous quality of service orientation, perhaps one that moves from an orientation toward curing
among younger people to one of caring among older people.
Segmenting bv educational level
The rehabilitation market can also be segmented on the basis of the educational level of consumers. Our findings suggest that education
influences preferences for a rehabilitation facility and quite different attributes are viewed as important by each educational group. Consumers
with a senior high school education value the competency and skills of their therapist while consumers with a junior high school education value
efficiency. Consumers with a primary school education are more focused on the competency and skill of the doctor. Thus both the most and the
least educated are oriented towards competency while those with an intermediate education are more concerned with efficiency.
Segmenting by duration of sick leave
The results dealing with duration of sick leave are interesting. Those who had a moderate duration of leave value competency more than any
other service attribute. Those with a long duration of leave seem to more highly value receiving information from staff about their injury. Again,
as with age, we may be seeing a change from an orientation towards an expectation of curing to one of caring. As the duration of the leave
lengthens, information from staff provides the consumer with support and a basis for developing useful adaptive strategies to help them accept
and cope with what has become a chronic condition. While the duration of sick leave is contingent on many social, economic, and political
factors (Kleinman, Brodwin, Good, & Del Vecchio Good, 1992), we can assume that in many cases the duration of the sick leave is associated
with the seriousness of the injury.
Segmenting bv length of time since in jury
Although length of time since injury is not one of the more significant segmenting variables, the differences are worthy of some
consideration. It appears that the length of time since injury may be associated with a change in what features are important to the consumer —
the structure or the personnel (more specifically the ability to make choices in regard to staff). Length of time since injury and, thus, length of
experience with treatment, rehabilitation facilities, and treatment personnel, may be associated with the ability to differentiate between the
appearance of the structure as an indicator of quality care and other factors, like characteristics of staff. We might consider the idea that new
clients in a competitive marketplace are attracted by things that look modem, fancy, and up to date because they may assume that such facilities
indicate that the knowledge and skills of the staff will also be modem and up to date. People who have been in the system for a longer period may
begin to realise that appearances do not necessarily equate with competency. Further, after significant periods in the rehabilitation system, and,
perhaps a long period of attendance at a particular facility, consumers may want to work with staff with whom they have become accustomed
and have developed a therapeutic relationship or those they have been able to identify as competent.
Variables like “duration of sick leave” and “length of time since injury” seem to warrant further investigation in terms of their influence on
consumer choices of rehabilitation services, particularly considering the ever increasing number of people who are living with a chronic
disability. Return to work and the cessation of disability or sick leave benefits do not necessarily signal the end of the need or desire for
rehabilitation services. Many people in this study were back at work but continued to use rehabilitation services. Consumers, in Hong Kong and
elsewhere, in their search for increased functional ability and relief from pain, often turn to alternate healing, and often do so at their own
expense. Consumers are willing, when they feel it is necessary, to spend their own money for services that address their needs and they feel will
provide a desired result.
Conclusion
42
Journal of Rehabilitation
AprMMayUune 1996
The results of this study suggest that within a heterogeneous rehabilitation market there are homogeneous segments associated with
socio-demographic and injury variables. In this
Journal of Rehabilitation
study, consumers between the ages of 17 and 25 and those w ith a primary school education value service attributes related to the competence of
physicians. Consumers between 26 and 35 and those with a senior high school education value sendee attributes related to the competency of
therapists. Consumers between 36 and 45 and those with a junior high school education value service attributes related to modern equipment and
sendee efficiency. Consumers aged 46 and above value sendee attributes relating to the quality of care of the sendees received. By combining the
information on the various variables and attributes we have developed a profile of this rehabilitation market, one that suggests that some
consumers, particularly the young, least educated, and those new to the market are drawn towards sendees that highlight technical factors,
modernity, and the skill and competency of the staff. While older consumers and those who have been affected by their injury for a longer period
of time are drawn towards services that highlight a sense of caring and concern.
As mentioned earlier in the introduction section, this study consisted of three parts, the findings of the second part were reported here. The

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
 last part involved the identification of perceptions and preferences of the sendees provided by hospitals, rehabilitation centers and the Workers’
Health Center (Ting, 1993). That survey was wdth consumers who have used rehabilitation services provided by a hospital, rehabilitation center
and WHC (N=l 8). Respondents were asked to rank order the three providers along those attribute factors identified in the first part of the study
(Ting, 1995). The findings indicated that WHC w'as perceived as the best in three areas: caring attitude of the medical staff, explaining procedure
and providing information to clients, and waiting time. Rehabilitation centers were perceived as the best in: effectiveness in examination and
treatment by doctors, competence of therapists, and location. Hospitals w'ere perceived as the best in facility and equipment.
The findings of the second and last part of the study increase our understanding of a local rehabilitation market and its consumers. Such
findings are important not only because they can help service providers to better address consumers’ needs and wants, but they also allow
rehabilitation providers to position services to gain an edge over competitors. For example, a rehabilitation center with competent doctors and
therapists will attract, and perhaps better serve, the felt needs of consumers aged 17-35. However, if the rehabilitation center aims at serving the
older consumers or people with long term disability, it has to develop strengths along the quality of care dimension.
The findings can also help rehabilitation providers examine their existing service policy. Take for instance WHC, which has a perceived
strength in providing a caring service, will attract older consumers. In order to expand occupational rehabilitation services, WHC must secure
and further strengthen its position as a market leader in serving the older consumers. The marketing mix decisions to support this objective are as
follows:
Service decision
As the core benefit sought by consumers is a recovery to his/her premorbid healthy state (Ting, 1995), WHC needs to expand its medical
service, which is currently diagnostic in nature, to cover a therapeutic component. The important contri-
AprWMayUune 1996 butions of the rehabilitation professionals should not be underestimated. Concurrently, it should continue to build on those
leading dimensions in quality of care, provision of information, and convenience of service.
Distribution decision
WHC should consider how it will make its services available and accessible to older consumers. The term “distribution” covers two relevant
aspects: physical access and time access. WHC has outperformed hospitals and rehabilitation centers in the time access which is another strength
of WHC. In relation to physical access, WHC needs to make its services more accessible. One way to make the services more accessible is to
deliver services directly to the consumer’s place of abode. This solution may be very costly and infeasible. Alternatively, WHC can deliver the
services through offices of the various workers’ unions.
Advertising and promotion decisions
Advertising and promotion activities should target older consumers. Pamphlets and promotional materials should clearly identify this target
segment. With limited resources, advertisements for sendees should only appear in those newspapers and magazines that appeal to the target
segment. Seminars and talks should also be selective.
Price decision
Consumers are relatively insensitive to price when they receive the core benefit. WHC should maintain its current two-tier pricing system.
It charges a competition-oriented price. That means it sets prices based on what the competitors are charging. The perceived value of the sendee
package is then higher for WHC than the other two groups. This is because WHC is providing caring and quality sendees sought by the target
consumers. This provides a competitive edge for WHC. The second tier price is offered to those who may have difficulties paying a nominal fee.
Alternate strategies may include widening the consumer base or repositioning to serve another segment(s). To decide on a particular
strategy, WHC needs to consider a number of factors. These include the mission of WHC, the objectives of major stakeholders, the growth
potential among segments, strengths and weaknesses of the potential competitors and of WHC.
This study supports the notion put forward by Smith and Clark (1990) that health care management on undifferentiated services is
inadequate in reflecting consumer perceptions within one health care market. Segmentation studies conducted overseas, largely in America,
confirm the existence of segments within a larger health care market (e.g., Berkowitz & Flexner, 1980-81; Boscarino & Steiber, 1982; Finn &
Lamb, 1986; Kautzmann, Kautzmann & Navarro, 1989). Therefore, rehabilitation providers should adopt a market-oriented strategy, and use
segmentation and positioning studies as one of the managerial tools to achieve a competitive edge.
The approach presented here and, perhaps, some of the findings should be useful to rehabilitation providers in other communities. It
illustrates how the results of this kind of study can help providers to achieve some of their objectives, such as those
43
44 Journal of Rehabilitation Apt
set out in the beginning of this paper. With this approach rehabilitation providers can obtain more information on the needs and characteristics of
segments within a heterogeneous market. This market information can assist the internal auditing process of the sendees provided, the
positioning of existing services, and/or the creation of new sendees to meet the needs of an undersened or high potential segment.
The strength of this approach is not only that it can help increase revenue in a climate of economic competition, but it provides a way to
better identify consumers’ needs and wants so they can be better addressed — whether or not the facility is a profit making organisation.
Rehabilitation sendees, to be truly successful, must address more than the medical and physical function needs of today’s consumers; they must
also address people’s felt needs and their criteria for high standards of care.
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