Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, London, UK.
Hum Resour Health. 2009 Jul 24;7:62. doi: 10.1186/1478-4491-7-62.
Although the factors influencing the shortage and maldistribution of health workers have been well-documented by cross-sectional surveys, there is less evidence on the relative determinants of health workers' job choices, or on the effects of policies designed to address these human resources problems. Recently, a few studies have adopted an innovative approach to studying the determinants of health workers' job preferences. In the absence of longitudinal datasets to analyse the decisions that health workers have actually made, authors have drawn on methods from marketing research and transport economics and used Discrete Choice Experiments to analyse stated preferences of health care providers for different job characteristics. We carried out a literature review of studies using discrete choice experiments to investigate human resources issues related to health workers, both in developed and developing countries. Several economic and health systems bibliographic databases were used, and contacts were made with practitioners in the field to identify published and grey literature. Ten studies were found that used discrete choice experiments to investigate the job preferences of health care providers. The use of discrete choice experiments techniques enabled researchers to determine the relative importance of different factors influencing health workers' choices. The studies showed that non-pecuniary incentives are significant determinants, sometimes more powerful than financial ones. The identified studies also emphasized the importance of investigating the preferences of different subgroups of health workers. Discrete choice experiments are a valuable tool for informing decision-makers on how to design strategies to address human resources problems. As they are relatively quick and cheap survey instruments, discrete choice experiments present various advantages for informing policies in developing countries, where longitudinal labour market data are seldom available. Yet they are complex research instruments requiring expertise in a number of different areas. Therefore it is essential that researchers also understand the potential limitations of discrete choice experiment methods.
尽管横断面调查已经充分记录了影响卫生工作者短缺和分布不均的因素，但关于卫生工作者工作选择的相对决定因素，或关于旨在解决这些人力资源问题的政策效果的证据较少。最近，一些研究采用了一种创新的方法来研究卫生工作者工作偏好的决定因素。由于缺乏分析卫生工作者实际做出的决策的纵向数据集，作者借鉴了营销研究和运输经济学的方法，并使用离散选择实验来分析医疗保健提供者对不同工作特征的偏好。我们对使用离散选择实验调查与卫生工作者有关的人力资源问题的研究进行了文献综述，这些研究在发达国家和发展中国家都有开展。使用了几个经济和卫生系统文献数据库，并与该领域的从业者联系，以确定已发表和灰色文献。发现了 10 项使用离散选择实验来调查医疗保健提供者工作偏好的研究。离散选择实验技术的使用使研究人员能够确定影响卫生工作者选择的不同因素的相对重要性。这些研究表明，非经济激励是重要的决定因素，有时比经济激励更重要。已确定的研究还强调了调查不同卫生工作者亚组偏好的重要性。离散选择实验是为决策者提供如何设计策略以解决人力资源问题的宝贵工具。由于它们是相对快速且廉价的调查工具，因此在发展中国家制定政策方面具有各种优势，这些国家很少有纵向劳动力市场数据。然而，它们是复杂的研究工具，需要在多个不同领域具备专业知识。因此，研究人员还必须了解离散选择实验方法的潜在局限性。
