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[巴西米纳斯吉拉斯州医学生对基层医疗工作的偏好:来自离散选择实验的证据]

[Preferences for work in primary care among medical students in Minas Gerais State, Brazil: evidence from a discrete choice experiment].

作者信息

Girardi Sabado Nicolau, Carvalho Cristiana Leite, Maas Lucas Wan Der, Araujo Jackson Freire, Massote Alice Werneck, Stralen Ana Cristina de Sousa van, Souza Osmar Ambrósio de

机构信息

Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.

Departamento de Matemática, Universidade Estadual do Centro-Oeste, Guarapuava, Brasil.

出版信息

Cad Saude Publica. 2017 Aug 21;33(8):e00075316. doi: 10.1590/0102-311X00075316.

Abstract

This article presents the results of a discrete choice experiment (DCE) conducted in 2012 with 277 final-year medical students from Minas Gerais State, Brazil. The experiment tested students' preferences concerning future work as physicians in primary health care, based on hypothetical job scenarios aimed at measuring the likelihood of placement in areas with a shortage of doctors. Application of DCE involved (i) a qualitative stage to define the attributes and their respective levels to comprise the job scenarios, (ii) construction and application of the instrument, and (iii) analysis with application of multinomial logit with conditional probability to estimate the weight of attributes and to construct scenarios for choice probability. The results indicate that the job attribute that most impacted students' choice was location, followed by job conditions, pay, access to medical residency, type of employment relationship, and workload. Students from private medical schools, with higher family income, and females were generally more likely to resist job assignments in unsafe urban areas and remote areas of the countryside. The job scenarios that proved most plausible in terms of public intervention were those that combined middle-level wages, good working conditions, and 10 to 20 bonus points on medical residency exams.

摘要

本文介绍了2012年对巴西米纳斯吉拉斯州277名医学专业最后一年学生进行的离散选择实验(DCE)的结果。该实验基于旨在衡量医生短缺地区就业可能性的假设工作场景,测试了学生对未来从事初级卫生保健医生工作的偏好。离散选择实验的应用包括:(i)一个定性阶段,以定义构成工作场景的属性及其各自的水平;(ii)工具的构建和应用;以及(iii)运用多项逻辑回归和条件概率进行分析,以估计属性的权重并构建选择概率的场景。结果表明,对学生选择影响最大的工作属性是工作地点,其次是工作条件、薪酬、获得医学住院医师培训的机会、雇佣关系类型和工作量。来自私立医学院、家庭收入较高的学生以及女性通常更有可能拒绝在不安全的城市地区和偏远农村地区工作。就公共干预而言,最合理的工作场景是那些结合了中等水平工资、良好工作条件以及医学住院医师考试10至20分加分的场景。

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