The health brain-drain in rural areas about the health personnel incentive policy intervention in Shanghai: a longitudinal study

Abstract

BackgroundThe so-called health brain-drain—which refers to the health workers leaving their present jobs to other institutions, especially in rural areas—severely restricts the development of primary healthcare. To solve the problem, Pudong New Area of Shanghai carried out a series of incentive policies such as salary bonus, promotion and housing from July, 2014. In our study we aimed to analyse the change in health brain-drain which resulted from this policy. MethodsThere are 45 community health centres in Pudong, which we classified into 4 categories by geographical division: remote rural, general rural, suburban, and urban. The policy only applied to the 32 community health centres classified as remote rural, general rural, and suburban. Healthcare personnel in these community health centres were given a monthly bonus of ¥1000–6000. We did an institutional survey about the quantity and structure of the overall and outflowed health personnel in all 45 community health centres from December 31, 2013, to December 31, 2015. This study was approved by the ethics committee of Pudong Institute for Health Development and was performed in compliance with the Declaration of Helsinki. FindingsThe overall rate of health brain-drain decreased from 8·1% (568/6996) in 2013 to 4·6% (302/6553) in 2015. The rate in community health centres in remote rural, general rural, and suburban areas decreased from 6·3% (298/4699) to 3·8% (170/4528), and from 11·8% (270/2297) to 6·5% (132/2025) in community health centres in urban areas. In community health centres in remote rural, general rural, and suburban areas, the rate of decline in general practitioners, public health physicians and clinicians, and nurses in decreased by 0·5 (from 1·75% to 1·22%), 2·0 (from 9·31% to 7·27%) and 4·6 (from 8·23% to 3·67%) percentage points, respectively, in 2015 compared with 2013. Moreover, in areas where highest bonuses were offered (remote rural), rates of decline were smaller than in areas where no bonuses were offered (urban): 0·0% versus 2·8% for general practitioners, 5·6% versus 9·7% for public health physicians and clinicians, and 2·6% versus 6·8% for nurses. InterpretationExternal economic incentives have relieved the health brain-drain in rural areas and the stability of general practitioners and nurses in remote rural areas has been strengthened. However, there was still unfavorable health brain-drain of public health physicians and clinicians in rural areas. Thus, the policy sustainability and health brain-drain of public health physicians should remain a concern. FundingNational Nature Science Foundation of China (#71503170) and Shanghai Municipal Commission of Health and Family Planning (#201540400, #201540134).