埃塞俄比亚医学研究生的农村工作偏好——离散选择实验（DCE）。
Rural job preferences of graduate class medical students in Ethiopia-a discrete choice experiment (DCE).
机构信息
Amhara Development Association, Woldia, Amhara, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Med Educ. 2023 Mar 13;23(1):155. doi: 10.1186/s12909-023-04133-3.
BACKGROUND
Human resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings.
METHODS
An discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested.
RESULTS
A total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively.
CONCLUSION
Rural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition.
背景
人力资源是卫生系统的基石之一，它最终会提高健康水平、公平性和效率。然而，卫生部门的人力资源存在流失率高、分布不均以及城乡之间地理不平等的特点。
方法
采用离散选择实验（DCE）方法，进行了 16 项选择任务，其中包括两个包含五个属性（工资、住房、药品和医疗设备、学习休假前的工作年限、管理支持和工作量）的模块。采用潜在类别和混合对数模型来估计农村工作偏好和异质性。此外，还计算了相对重要性、意愿接受程度和边际选择概率。最后，测试了偏好与年龄和性别的相互作用。
结果
共有 352 名（5632 个观察值）即将毕业的医学生完成了选择任务。平均而言，受访者更愿意在工资较高且住房补贴较好的地方工作。此外，受访者还希望在提供服务一年后有教育机会、管理支持且工作量正常的情况下，在药品和医疗设备库存充足的医疗机构工作。年轻的医学生比年长的学生更倾向于较低的服务年限。除了年龄和服务年限外，我们没有发现年龄/性别与农村工作偏好属性之间的交互作用。一个三类别潜在类别模型最适合数据。在类别 1 和 3 中，工资是最重要的属性。与其他类别相反，类别 2 的受访者对工资没有明显的偏好。受访者愿意接受额外的 4271 比尔（104.2 美元）、1998 比尔（48.7 美元）、1896 比尔（46.2 美元）、1869 比尔（45.6 美元）和 1175 比尔（28.7 美元），用于补偿药品和医疗设备供应不足、强制服务两年、工作量大、管理不支持以及基本住房。
结论
医学生对农村工作的接受程度受到所有属性的影响，并且存在个体和群体层面的偏好异质性。决策者应该考虑到工作偏好和异质性，以激励医学毕业生到农村地区工作，并减少人员流失。
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