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印度农村临床医生短缺与医生和护士工作偏好:离散选择实验。

Rural clinician scarcity and job preferences of doctors and nurses in India: a discrete choice experiment.

机构信息

Public Health Foundation of India, New Delhi, India.

Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.

出版信息

PLoS One. 2013 Dec 20;8(12):e82984. doi: 10.1371/journal.pone.0082984. eCollection 2013.

Abstract

The scarcity of rural doctors has undermined the ability of health systems in low and middle-income countries like India to provide quality services to rural populations. This study examines job preferences of doctors and nurses to inform what works in terms of rural recruitment strategies. Job acceptance of different strategies was compared to identify policy options for increasing the availability of clinical providers in rural areas. In 2010 a Discrete Choice Experiment was conducted in India. The study sample included final year medical and nursing students, and in-service doctors and nurses serving at Primary Health Centers. Eight job attributes were identified and a D-efficient fractional factorial design was used to construct pairs of job choices. Respondent acceptance of job choices was analyzed using multi-level logistic regression. Location mattered; jobs in areas offering urban amenities had a high likelihood of being accepted. Higher salary had small effect on doctor, but large effect on nurse, acceptance of rural jobs. At five times current salary levels, 13% (31%) of medical students (doctors) were willing to accept rural jobs. At half this level, 61% (52%) of nursing students (nurses) accepted a rural job. The strategy of reserving seats for specialist training in exchange for rural service had a large effect on job acceptance among doctors, nurses and nursing students. For doctors and nurses, properly staffed and equipped health facilities, and housing had small effects on job acceptance. Rural upbringing was not associated with rural job acceptance. Incentivizing doctors for rural service is expensive. A broader strategy of substantial salary increases with improved living, working environment, and education incentives is necessary. For both doctors and nurses, the usual strategies of moderate salary increases, good facility infrastructure, and housing will not be effective. Non-physician clinicians like nurse-practitioners offer an affordable alternative for delivering rural health care.

摘要

农村医生的短缺削弱了印度等中低收入国家卫生系统向农村人口提供优质服务的能力。本研究考察了医生和护士的工作偏好,以了解农村招聘策略的效果。比较了不同策略的工作接受情况,以确定增加农村地区临床服务提供者供应的政策选择。2010 年,在印度进行了一项离散选择实验。研究样本包括医学和护理专业的应届毕业生,以及在初级保健中心工作的在职医生和护士。确定了 8 个工作属性,并使用高效分数阶设计构建了工作选择对。使用多层逻辑回归分析了受访者对工作选择的接受情况。位置很重要;提供城市设施的地区的工作更有可能被接受。较高的工资对医生的接受程度影响较小,但对护士的接受程度影响较大。在目前工资水平的五倍时,13%(31%)的医学生(医生)愿意接受农村工作。在这个水平的一半时,61%(52%)的护理学生(护士)接受农村工作。为专科培训预留席位以换取农村服务的策略对医生、护士和护理学生的工作接受程度有很大影响。对于医生和护士来说,人员配备充足、设备齐全的卫生设施和住房对工作接受程度的影响较小。农村出身与农村工作接受程度无关。激励医生到农村服务的成本很高。需要一种更广泛的策略,即大幅提高工资,改善生活、工作环境和教育激励措施。对于医生和护士来说,适度提高工资、良好的设施基础设施和住房等常见策略将不会有效。非医师临床医生,如护士从业者,为提供农村医疗保健提供了一种负担得起的替代方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efbe/3869745/7da35675b109/pone.0082984.g001.jpg

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