Abstract
BackgroundChina has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final–year students in a medical university in Guizhou Province, China.MethodsAttributes of potential jobs were developed through the literature review, semi–structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates.ResultsThe final sample comprised 787 medical and nursing students. The statistically significant results indicated “Bianzhi” (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background.ConclusionsStrategies for patient–doctor relationships, Bianzhi and salary should be considered to attract final–year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.
Highlights
The uneven distribution of health workers reduces access to essential health services and contributes to inequalities in health outcomes [1]
We aimed to explore factors likely to affect the job preferences of final–year medical and nursing students in order to assist policy makers in designing interventions to attract qualified students to rural areas
Anywhere between 20 and 50 respondents per experiment group are required to reliably estimate respondent preferences [23]; all final–year medical and nursing students were invited to participate in the study
Summary
The uneven distribution of health workers reduces access to essential health services and contributes to inequalities in health outcomes [1]. Studies have cast light on the systematic categories of imbalances in the health workforce that affect the medical system, including geographic, institutional, professional and ownership imbalances [2]. From the standard deviation of the regression coefficients, we found significant preference heterogeneity exits over the availability of transportation, workload of 40 h per week, the availability of essential equipment, physical conflict between patients and doctors, lawsuits and Bianzhi for both medical and nursing students. Mean utility coefficients are the basis for the WTP estimations which can be compared across different groups [29]. These measures predict how much salary a final–year student is willing to sacrifice in exchange for an improvement in a particular job attribute. Students were willing to forego RMB¥954 (USD$141) in exchange for jobs with adequate essential equipment
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