Migriño Julius R
San Beda University College of Medicine, San Miguel, Manila, Philippines.
Ateneo School of Medicine and Public Health, Pasig City, Philippines.
Cent Asian J Glob Health. 2020 Mar 31;9(1):e344. doi: 10.5195/cajgh.2020.344. eCollection 2020.
Timely empirical evidence is important in the success of health systems, and such evidence is necessary for informed policy making to address inequity in the health workforce. Literature is ripe with incentives that affect recruitment and retention of physicians in rural and remote areas, but such data in still lacking in the Philippine setting. Discrete choice experiment is one methodology utilized by the World Health Organization which provides both qualitative and quantitative information to aid policy makers in health human resource management.
The study utilized a discrete choice experiment involving three phases: 1) identification of incentives and levels using key informant interviews and focus group discussions, 2) selection of scenarios utilizing an experimental design, and 3) administration of survey based on WHO guidelines. Conditional logistic regression, point estimates, and correlational analyses were done using Stata.
There is significant association between type of background and considerations for rural practice among the respondents based on Pearson's correlation (p < 0.01). The respondents put more value into non-wage rural job posting incentives than small to modest base salary increases. The high willingness to pay for the presence of supervision, relative location of work areas from families, and status of workplace infrastructure/equipment or supplies suggest the importance of workplace conditions to attract rural health physicians. Combinations of wage and non-wage incentives may be necessary to provide for the most cost-efficient increases in rural job post uptake rates based on post-estimate calculations.
Philippine medical interns and young doctors value non-wage incentives in considering rural health job postings. Rural health job postings with these incentives are predicted to significantly increase recruitment in rural health job posts, particularly when combinations of wage and high-impact non-wage incentives are considered.
及时的实证证据对卫生系统的成功至关重要,此类证据对于制定明智的政策以解决卫生人力方面的不平等现象是必要的。关于影响农村和偏远地区医生招聘与留用的激励措施,已有大量文献,但菲律宾的相关数据仍很缺乏。离散选择实验是世界卫生组织采用的一种方法,它能提供定性和定量信息,以协助卫生人力资源管理方面的政策制定者。
本研究采用了一项包含三个阶段的离散选择实验:1)通过关键信息人访谈和焦点小组讨论确定激励措施及其水平;2)利用实验设计选择情景;3)根据世界卫生组织的指南进行调查管理。使用Stata进行条件逻辑回归、点估计和相关性分析。
根据Pearson相关性分析,受访者的背景类型与对农村执业的考虑因素之间存在显著关联(p < 0.01)。受访者对农村非工资岗位发布激励措施的重视程度高于小幅至适度的基本工资增长。对有监督、工作地点与家庭的相对位置以及工作场所基础设施/设备或物资状况的高支付意愿表明,工作场所条件对吸引农村卫生医生很重要。根据估计后计算,工资和非工资激励措施的组合可能是实现农村岗位录用率最具成本效益增长的必要条件。
菲律宾医学实习生和年轻医生在考虑农村卫生岗位发布时重视非工资激励措施。预计有这些激励措施的农村卫生岗位发布将显著增加农村卫生岗位的招聘,特别是在考虑工资和高影响力非工资激励措施组合的情况下。