Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.
Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.
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DOI：
10.1371/journal.pone.0050567
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Huicho L
中科院分区：
文献类型：
--
作者：
Miranda JJ;Diez-Canseco F;Lema C;Lescano AG;Lagarde M;Blaauw D;Huicho L
在拉丁美洲和秘鲁，农村地区医生短缺仍然是一个严重的问题。很少有研究探讨在医疗服务不足地区工作的医生的职业偏好。我们的目的是调查医生对农村工作的偏好。在秘鲁服务不足的阿亚库乔省进行了标记离散选择实验（DCE）。对三个地点的偏好进行了评估：农村社区、阿亚库乔市（阿亚库乔的首府）和其他省会城市。进行了政策模拟，以评估工作属性对接受农村职位的影响。使用多重条件逻辑回归来评估工作属性和个人特征的相对重要性。共有102名医生参与。他们选择阿亚库乔市工作岗位的可能性是农村社区的五倍（OR 4.97, 95%CI 1.2; 20.54）。工资的增加和专业化的奖励点数是选择农村地区的激励因素，而获得长期职位所需年数的增加则是一种抑制因素。男性在医院工作大大降低了选择农村工作的机会，而没有伴侣生活则增加了选择农村工作的机会。政策模拟显示，75%的加薪、在农村地区工作两年后获得一份永久合同、以及进一步专业化获得奖励积分等一揽子措施，将农村工作的就业率从21%提高到77%。50%的工资增长加上进一步专业化的奖励积分，也将使农村的就业率从21%提高到52%。在城市工作的医生比在农村工作的医生多出五倍。这种强烈的偏好需要通过旨在改善乡村医生稀缺状况的未来政策来克服。一些激励措施，单独或联合起来，似乎是可行和可持续的，而另一些则可能造成沉重的财政负担。
Doctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs. A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.
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