An Analysis of the Value and Profitability of Horticulture-Based Agro-healing Programs for Depression Reduction
Article information
Abstract
Background and objective
This study analyzed the economic value of horticulture-based Agro-healing (HBAH) programs and considered how they can achieve profitability, as basic research for their sustainable operation.
Methods
The research target program is an HBAH program for depression reduction, targeting groups diagnosed with depression or at high-risk of depression from 19 to 65 years old. A survey was conducted with 95 individuals related to Agro-healing, and based on the survey results, an analysis was performed on the replaceable cost, market size, and profitability by considering the medical expenses of depression patients, the consumer spending items that can be replaced by the effects of therapeutic farming programs, the remuneration for Agro-healing specialists and auxiliary personnel, and the appropriate number of such personnel.
Results
An analysis of the cost scale that HBAH programs can replace found that the replaceable cost could be about 2.8 trillion won. By combining the number of mental health institutions and care farms, and the number of eligible participants, it was found that assuming that six sessions run in a year, 256,400 people will participate at approximately 2,850 institutions and farms in 2028., enabling the programs to run 17,100 sessions in 2028. Profitability should be ensured for the sustainable operation of Agro-healing programs. In this regard, it was confirmed that participation fees should range from a minimum of 31,211 won to a maximum of 45,346 won per session.
Conclusion
This study is meaningful in that it performed a basic analysis of the economic value of individual Agro-healing programs and a profitability analysis for the sustainable operation of Agro-healing programs.
Introduction
Agro-healing, also known as social farming, and referred to in Korea as "agro-healing," is an industry that creates social or economic added value by using various agricultural and rural resources and related activities to promote the recovery, maintenance, and improvement of people’s health (Act on the Research, Development, and Promotion of Agro-Healing, 2024). There is an increasing need for Agro-healing to utilize resources to improve people’s health and quality of life, and the growth of sustainable agriculture and rural communities. A legal basis for Agro-healing was established with the enactment of the Act on Research, Development and Promotion of Agro-Healing (hereinafter referred to as the Agro-Healing Act) in 2020, and the Comprehensive Plan for Research, Development and Promotion of Agro-Healing (2022–2026) was established and is being implemented.
The scope of Agro-healing includes not only the use of plants such as vegetables and flowers, but also livestock raising, forests, and rural cultural resources. Its purpose is to help people seeking healthier and happier lives, as well as those in need of medical and social treatment, to recover their health. Its main difference from general farming is that farming itself is not an end, but rather a means to restore health (Rural Development Administration (RDA), 2024). Research and development in Agro-healing began with horticultural therapy, promoted by the National Institute of Horticultural and Herbal Science under the RDA. Since 2013, the National Institute of Agricultural Sciences has been researching insect-mediated therapy and rural care-farming tourism, while the National Institute of Animal Science has focused on animal-assisted therapy (RDA, 2024). The terms initially used by each research institute have been unified under the term "agro-healing," and an integrated policy foundation has been established with the enactment of the Agro-Healing Act in 2020, which is now being implemented.
Research on Agro-healing covers a wide range of topics, and includes many studies on its effectiveness in various health domains, and those related to policies and systems, as well as some economic value analyses. Kim and Ha (2018) found that the accessibility, safety, and facilities of Agro-healing affect people’s intention to use these services. Ko and Heo (2020), in a study exploring the relationship between supply conditions for activating oAgro-healing, the composition of programs offered, and participants’ intention to use the services, reported that greater awareness of the need for crop cultivation, animal-mediated therapy, nature activities, and cultural activities was associated with a higher intention to use such services. Moon and Lee (2023) reported that accessibility, expertise, and perceived cost significantly influence perceived value and the intention to use Agro-healing, based on the value-based adoption model. Beyond its simple therapeutic effects, determining the economic value of Agro-healing seems to be crucial for expanding Agro-healing policies. It is also important to explore the potential for developing a profit model by understanding profitability levels, as well as to assess the feasibility and sustainability of investment based on this. Notably, Agro-healing was found to have a significant effect on reducing depression, a condition characterized by a decline in overall mental functioning, including thoughts, motivation, desires, interest, behavior, sleep, and physical activity, along with a decrease in mood. When depression is so severe that it makes it difficult to carry out daily activities, it is called major depressive disorder; if the symptoms are mild or of short duration, it is called minor depressive disorder. Horticultural activities have been introduced as psychotherapeutic programs in various social service categories, including for the disabled, the elderly and children, and their effectiveness has also been proven (Lee and Yeo, 2020). Treatment using plants and gardening activities was first recorded in ancient Egypt, where garden walks were prescribed for mental stability. Studies have shown that activities such as digging, cultivating soil, and walking in gardens were effective for psychiatric patients (Simson et al., 1997). Lee et al. (2013) analyzed the effects of a horticultural therapy program on depression in prisoners preparing to re-enter society. The 12-session program significantly reduced depression in the experimental group, suggesting that horticultural therapy could be used to reduce depression in prisoners. Horticultural activities have also been shown to be effective in alleviating depressive disorders in older adults and those with dementia (Song, 2009; Jeong, 2009), as well as in improving mental health and reducing depressive symptoms in institutionalized older people (Kim & Park, 2015; Lim, 2015). Jeong et al. (2023) applied a Agro-healing program (focused on gardening activities) to college students at high risk of stress, and confirmed its effectiveness. The analysis results showed significant reductions in stress, depression, and anxiety. As such, many studies have demonstrated that horticultural activities have a positive effect on reducing depression and depressive disorders.
Therefore, in this study, we assumed that among various Agro-healing resources, horticulture-based Agro-healing (HBAH) programs could replace some of the costs associated with treating depressive disorders and reducing depression. The study was conducted to determine the size of the replaceable costs and of the market, and the profitability required to achieve the target operating profit. However, since the field of Agro-healing is vast and diverse, this study focused on analyzing the economic value of HBAH programs and exploring their potential as non-pharmacological interventions for reducing depression.
Research Methods
Composition of a horticulture-based Agro-healing program for alleviating depression
The program used for analysis in this study is an HBAH program to alleviate depression, where "depression" refers to both depression and depressive disorder, thus limiting its scope. Furthermore, in the introduction, it was assumed that an HBAH program would replace the costs of treating depressive disorders and alleviating depression, but the program used for analysis in this study was presented based on a report suggesting that interpersonal depression (p = .041*) and depressive emotions (p = .049*) were statistically significantly reduced among participants in the program, as part of the Agricultural Policy Support and Technology Development Project (RS-2021-RD009877; RDA, 2023).
The HBAH program for reducing depression, which was the subject of this study, targeted adults aged 19-65 who had been diagnosed with depression or were at high risk of developing it. The program was delivered over a total of eight sessions (once a week for two months), based on the findings of Lee et al. (2015, 2016) that horticultural therapy effects were observed even in an eight-session program, and the opinion of J Mental Health Institution officials that extending the program beyond two months could lead to problems with participant retention due to absenteeism or discharge. It aimed to provide the effect of reducing depressive disorders and depression, by allowing participants to experience the full life cycle of plants, exposure to sunlight, appropriate physical activity, and psychological and emotional support interventions. The program was divided into three stages: plant propagation, management, and use. It incorporated core cognitive-behavioral strategies as therapeutic interventions, including perception of distorted thinking, problem-solving, socialization, and rewards and reconstruction of distorted thinking (Table 1).
A basic survey for profitability analysis of horticulture-based Agro-healing programs for alleviating depression
An online survey was conducted in October 2023 to analyze the profitability of HBAH programs for alleviating depression. The survey targeted 95 participants involved in Agro-healing, including care-farming specialists, graduates of care-farming training courses, operators of care-farming facilities, and representatives/personnel from care-farming-related organizations, such as the RDA, Korea Agriculture Technology Promotion Agency (KOAT), provincial agricultural research services, agricultural technology centers, and Agro-healing training institutes. The survey subjects were selected because care-farming specialists, graduates of care-farming training courses, and operators of care-farming facilities were considered key stakeholders. Representatives/personnel from care-farming-related organizations were also included, as they are responsible for care-farming policies, startup support, local rural development projects, and training care-farming specialists. The questionnaire included questions on consumption expenditure items potentially related to reducing depression, the remuneration for care-farming specialists necessary to run a HBCF program, and the appropriate number of assistants needed and their remuneration. For consumption expenditure items, the items of consumption expenditure from the Korea Household Income and Expenditure Survey were presented, and respondents were allowed to choose. For remuneration and number of assistants, an explanation of the program and examples of comparable remuneration were provided, and respondents were asked to respond. Examples of comparable remuneration included: 84,000 won/90 minutes for private university lecturers (information published by the Ministry of Education); 110,000 won/day for first-grade forest therapy instructors (guidelines for the selection and operation of forest therapy instructors); and 230,000 won/90 minutes and 250,000 won/90 minutes for second-grade general instructors (instructor remuneration standards set by local government human resource development centers and the RDA, respectively).
Regarding the demographics of the survey respondents, there were 19 males(20%) and 76 females(80%). By age, the largest group was 50 – 59, with 45 people (47.4%), followed by 28 (29.5%) in the 40 – 49 age group, 11 (11.6%) in the 30–39 age group, and smaller numbers in the 20 – 29 and 60+ age groups. Among the respondents’ occupations, the most common were representatives/personnel from care-farming related organizations (40, or 42.1%), followed by 21 self-employed (22.1%), 14 farmers, 12 sales/service workers, and 4 each of housewives and students. Regionally, the largest group of respondents came from Gyeonggi-do (including Incheon) with 27 people (28.4%), followed by Jeolla-do (including Gwangju) with 26 (27.4%), Seoul (18), Gyeongsang-do (including Daegu, Ulsan, and Busan) with 16, Chungcheong-do (6), and Gangwon-do (2). The general characteristics of the respondents are shown in Table 2.
Cost analysis of horticulture-based Agro-healing programs for alleviating depression
The cost of running a program includes material, tool and labor costs. Material costs were estimated based on the preparation required for each session of the program, which runs once a week for two months (eight sessions in total) with 15 participants. Tool costs were estimated based on the purchase of tools that could be used repeatedly, rather than just for a single session. A list of the materials and tools used for each session is presented in Table 3. Labor costs were estimated under two scenarios, derived from a survey of those involved in Agro-healing, depending on the appropriate remuneration and the number of assistants required.
Analysis of the size of the replaceable cost for alleviating depression
An analysis of the size of the replaceable cost for reducing depression was conducted based on depression experience rates by year and age, using regional data on mental illness and depressive disorder treatment from the Health Insurance Review & Assessment Service (HIRA; Korea Public Data Portal, 2024b). The population experiencing depression was estimated by multiplying the depression experience rate by the total population. As the depression experience rate is surveyed biennially, the experience rate from 2021 was used, with the population data based on figures from 2022.
Assuming that an HBCF program for depression reduction, which is the subject of analysis in this study, effectively reduces depression and depressive disorders, the size of the replaceable cost was analyzed by adding the medical and other expenses for depression reduction and depressive disorder treatment; the degree of depression reduction was not considered, and the expenditure items for depression reduction were selected based on the Korea Household Income and Expenditure Survey of Statistics Korea. The items presented in the survey are categorized into alcohol/tobacco (e.g., alcoholic beverages and cigarettes), clothing/footwear, household goods/services, health care, entertainment/culture, food/accommodations (e.g., meal and lodging expenses), and other goods and services. Clothing/footwear includes textiles and outerwear, innerwear, other clothing, clothing services, footwear, and footwear services. Household goods/services include furniture and lighting, interior decoration, furniture/lighting and decoration services, household textiles, appliances, appliance-related services, housewares, household tools and miscellaneous, household supplies, and housekeeping services. Health care includes pharmaceuticals, medical supplies, healthcare products and equipment, outpatient medical services, dental services, other medical services, and hospitalization services. Entertainment/culture includes audio-visual equipment, photo-optical equipment, information processing equipment, recording media, repair of audio-visual and information processing equipment, recreational and cultural durables, musical instruments, maintenance and repair of recreational and cultural durables, toys and beauty goods, camping and sporting goods, floral products, pet products, floral and pet services, sports and entertainment services, cultural services, lottery tickets, books, other printed materials, stationery, and group travel expenses. Other goods and services include hairdressing/beauty services, hairdressing/beauty equipment, hygiene and hairdressing/beauty products, watches and accessories, other personal goods, welfare facilities, insurance, other financial services, and other services. Respondents were asked to select all the items they thought would have a positive effect on reducing depression and treating depressive disorders. Eleven items, which were selected by the majority of respondents, were determined.
Since the HBCF program for depression reduction lasted 8 weeks, the expenditure for the 8-week period (2 months) was multiplied by the number of people experiencing depression to analyze the size of the replaceable cost for reducing depression.
Results and Discussion
Costs of horticulture-based Agro-healing programs for alleviating depression
The cost of running a program consisted of the cost of materials, tools and labor.
The material costs represent the expenses for the preparations required for an 8-session, 2-month operation involving 15 participants, as summarized in Table 4. The sessions include: 1st session - sowing; 2nd session - cutting; 3rd session - transplanting vegetables and flowers; 4th session - pest control; 5th session - transplanting sown plants; 6th session - fertilizing; 7th session - flower decoration; and 8th session - cooking for the garden party. The tool costs refer to the expense of purchasing tools that can be used throughout the program, rather than just once, and totaled 599,200 won. A survey was conducted among those involved in Agro-healing to gather their opinions, which indicated that the remuneration for Agro-healing specialists and assistants was 230,000 won per session and 100,000 won per session, respectively. Two scenarios were set up based on the number of assistants, either 1 or 2 (Table 4).
The size of replaceable costs for alleviating depression
According to the 2021 National Health Statistics (Korea Public Data Portal, 2024a), the depression experience rate in Korea is 11. 3%. Table 5 below shows the rates by year and age.
The population aged 19–65 in Korea is 35 million, and of these, the number who have experienced depression is estimated to be 3.78 million, based on population registration data by age from Statistics Korea. The breakdown of the population with depression experience by age is shown in Table 6.
The Korea Household Income and Expenditure Survey from Statistics Korea was used to identify expenditure items related to reducing depression. Of these, 11 items were identified that were selected by the majority of respondents in a survey of expenditure items considered relevant to reducing depression: meal expenses, flower-related goods, beauty/hairdressing services, interior design, welfare facilities, audio/video equipment, accommodation expenses, alcohol, cultural services, flower and pet services, and textiles and outerwear. Moreover, as the program analyzed in this study lasts for 8 weeks, the cost for depression relief was calculated on this basis (Table 7).
Thus, the size of the replaceable cost was estimated to be approx. KRW 2.7 trillion by multiplying the expenditure for 8 sessions over 2 months, as shown in Table 7, by the population experiencing depression, as estimated in Table 5. Since the program analyzed in this study targeted not only individuals who had experienced depression but also those at high risk of depression, it may also be applicable to patients currently undergoing treatment for depressive disorder. According to HIRA data on major mental illnesses by region from the Korea Public Data Portal (2023), 1,027,676 patients received treatment for depressive disorders in 2022. The total number of hospital days for these patients was 8,060,800, with the cost of care benefits amounting to KRW 537.765 billion (Table 8). However, patients with acute depression were excluded from the program, as their symptoms were considered too severe to allow their participation. The participation rate was set at 50%, accounting for those who missed the program among the remaining patients. The replaceable cost for patients with depressive disorders was analyzed to be 45 billion won (Table 8).
Market size of Agro-healing programs for alleviating depression
To analyze the market size of oAgro-healing programs for reducing depression, the number of mental health institutions and Agro-healing facilities where such programs can be implemented was taken into account. According to the resource book on mental health institutions in Korea (National Center for Mental Health, 2023), the number of mental health institutions is increasing year by year, with a compound annual growth rate (CAGR) of 7.93% from 2018 to 2022, as shown in Table 9 below.
Moreover, to estimate participants eligible for the Agro-healing program, the annual growth rate (AGR), in addition to the CAGR, was also analyzed. In 2022, the AGR increased by 3.4% from 2021. With an AGR of approx. 3%, the status of mental health institutions was analyzed, and is expected to grow from approx. 2,200 institutions in 2024 to 2,500 in 2028. The number of participants eligible for the Agro-healing program was found to increase from approx. 200,000 in 2024 to 230,000 in 2028 (Table 10).
According to the Comprehensive Plan for Research and Development and Promotion of Agro-healing (2022–2026), there were 82 care farms in 2022, with a target of reaching 200 by 2026. Using a linear growth model, this suggests an increase of 30 care farms each year, to reach a total of 260 by 2028 (Table 9). Based on the number of care farms, with the assumption that 15 people attend each session once a week and six sessions are held per year, the estimated number of participants is 12,690 in 2024 and 23,400 in 2028 (Table 11).
By combining the number of mental health institutions and care farms, along with the number of eligible participants, it was estimated that up to 215,700 people could participate in approx. 2,400 institutions in 2024. Assuming six sessions per year, a total of 14,400 sessions could be held. In 2028, an estimated 256,400 people could participate in around 2,850 institutions, with a total of 17,100 sessions (Table 12).
Profitability of horticulture-based Agro-healing programs for alleviating depression
A profitability analysis of the operation of an HBCF program for alleviating depression was conducted to identify an appropriate participation fee, the aim of which was to achieve a target operating-profit-to-turnover ratio in terms of generating sufficient profit for its sustainable operation.
Scenario 1
To analyze the participation fee based on the number of program operations conducted and a target operating-profit-to-turnover ratio, Scenario 1 set the remuneration for a Agro-healing specialist at 230,000 won and for an assistant at 100,000 won; a unit program, consisting of 15 participants across 8 sessions, was set, covering programs 1 to 10. Material and labor costs increased with the number of sessions, while tool costs were fixed and incurred only once, regardless of the number of sessions. The target operating profit ratio was set at 5% and 10%, and the participation fee per session was analyzed to range from 31,200 to 37,900 won (Tables 13, 14).

Scenario 1: Profitability of a 5% operating profit ratio in a horticulture-based Agro-healing program for reducing depression
Scenario 2
To analyze the participation fee based on the number of program operations conducted and a target operating profit-to-turnover ratio, Scenario 2 sets the remuneration for a Agro-healing specialist at 230,000 won and for an assistant at 100,000 won. A unit program, consisting of 15 participants over 8 sessions, was established, covering programs 1 through 10. The target operating profit-to-turnover ratio was set at 5% and 10%, and based on this, the participation fee per session was analyzed to range from 38,200 to 45,300 won (Table 15, 16). According to the Chungnam National University Industry-Academic Cooperation Foundation (2019), the average maximum willingness to pay for horticultural therapy activities was found to be approx. 14,800 won. However, the amount estimated in this study is 2 to 3 times higher. Even considering the estimate that willingness to pay may have increased due to inflation and the growing awareness of Agro-healing, this remains a very high level. Therefore, there is an urgent need to implement policy support measures to bridge the gap between consumers’ willingness to pay and the participation fee determined in this study, in order to make Agro-healing profitable.

Scenario 2: Profitability of a 5% operating profit-to-turnover ratio in a horticulture-based Agro-healing program for reducing depression

Scenario 2: Profitability of a 10% operating profit-to-turnover ratio in a horticulture-based Agro-healing program for reducing depression
According to Lee (2007), the profit generated by horticultural therapy for individuals with mental disabilities was estimated at 1.227 billion won in 2015, with an economic spillover effect of 13 billion won when the potential market for mental health-related institutions was fully realized in 2010. Furthermore, Kim et al. (2017) suggested a market size for 26 activities that can be classified as Agro-healing to be 39 trillion won. Assuming that the HBCF program for reducing depression presented in this study is one of the 26 activities presented by Kim et al. (2017), a simple calculation results in a market size of 1.5 trillion won. The current value derived in this study is 27.7 billion won, which is higher than the estimate of Lee (2007) but lower than the market size estimated by Kim et al. (2017). However, considering factors such as future inflation rates, the number of mental health institutions, the number of people with mental health promotion needs, and other Agro-healing resources beyond horticulture, the potential for growth in Agro-healing appears to be substantial.
Conclusion
Agro-healing can be defined as an activity and industry that promotes physical, emotional, psychological, cognitive, and social well-being, and its significance is growing. This study aimed to analyze the economic value of a horticulture-based Agro-healing (HBCF) program and its profitability for sustainable operation. The main findings are summarized below.
First, an analysis of the costs that can be replaced by HBCF programs that are effective in reducing depression and depressive disorders was analyzed to be about 2.8 trillion won. Second, by combining the total number of mental health institutions and care farms, along with the number of eligible participants, it was estimated that, assuming six sessions are held per year, approx. 256,400 people will participate across about 2,850 institutions and farms, enabling the programs to run 17,100 sessions in 2028. Third, profitability should be ensured for the sustainable operation of Agro-healing programs. In this regard, an analysis of the participation fee calculation to achieve the target operating profit under different scenarios indicated that the fee should range from a minimum of 31,211 won to a maximum of 45,346 won per session.
This study is significant as it provides a basic analysis of the economic value of Agro-healing programs, along with a profitability analysis for their sustainable operation. However, this study has limitations, including the small number of respondents, the lack of additional surveys required for an economic value analysis, a market size analysis that did not account for market share or distribution rates, and an estimate of the number of mental health institutions and Agro-healing facilities based on maximum values. Moreover, this study has limitations in that it does not reflect the costs involved in establishing and managing Agro-healing facilities, and it was limited to a profitability analysis of a single program consisting of eight sessions. Therefore, further research will be necessary to address these limitations and provide a comprehensive economic analysis for a wider range of programs.
Notes
This study was supported by the 2024 Horticultural and Herbal Science Program of the National Institute of Horticultural and Herbal Science of the Rural Development Administration (RS-2021-RD009877).
References
Act on the Research, Development, and Promotion of Agro-healing. 2024. Act No. 17437