Matiwane Busisiwe Precious, Rispel Laetitia C, Blaauw Duane
Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2025 Apr 15;20(4):e0320854. doi: 10.1371/journal.pone.0320854. eCollection 2025.
Regulating multiple job holding (MJH) among health professionals is challenging for many health systems. The effectiveness of different MJH policy reforms depends on the behavioural responses of different groups of health professionals but little is known about their preferences and likely reactions.
Investigate the preferences of public sector medical doctors, professional nurses, and rehabilitation therapists for different MJH regulations in two South African provinces.
We developed a novel discrete choice experiment (DCE) to evaluate the preferences of health professionals for jobs with varying MJH policy interventions. The DCE attributes included restrictive regulations (banning MJH) versus reward-oriented policies (increased public sector salaries, expanded overtime, improved clinical practice environment, and better hospital management). We produced an unlabelled DCE using an efficient design and administered it to a representative sample of health professionals. Generalized multinomial logit models were used for analysis. We also investigated group heterogeneity, calculated marginal willingness to pay and estimated uptake for different policies.
1387 participants completed the DCE. The doctors, nurses and rehabilitation therapists were strongly opposed to banning MJH, requiring salary increases of 45.7%, 20.0% and 42.8%, respectively, to accept an MJH ban. Increased public sector salaries significantly increased public sector retention. However, non-financial interventions were also influential. Doctors, nurses, and rehabilitation therapists were willing to forgo 57.9%, 54.8%, and 38.9% of their salaries, respectively, for an improved clinical practice environment. Competent hospital management was also important. There was some preference heterogeneity. Nurses had significantly different preferences for certain attributes compared to the other two groups, and professionals currently engaged in MJH were significantly more opposed to banning MJH.
This study provides new information on health professional preferences for different MJH regulations. It confirms the importance of non-financial policy interventions in addressing MJH and the need to tailor MJH policy design.
对许多卫生系统而言，规范卫生专业人员的多重职业持有（MJH）颇具挑战。不同的MJH政策改革的有效性取决于不同卫生专业人员群体的行为反应，但对于他们的偏好和可能的反应却知之甚少。
调查南非两个省份的公共部门医生、专业护士和康复治疗师对不同MJH规定的偏好。
我们开展了一项新颖的离散选择实验（DCE），以评估卫生专业人员对具有不同MJH政策干预措施的工作的偏好。DCE属性包括限制性规定（禁止MJH）与奖励导向型政策（提高公共部门薪资、增加加班时间、改善临床实践环境以及优化医院管理）。我们采用高效设计制作了一个无标签的DCE，并将其应用于具有代表性的卫生专业人员样本。使用广义多项logit模型进行分析。我们还调查了群体异质性，计算了边际支付意愿，并估计了不同政策的接受程度。
1387名参与者完成了DCE。医生、护士和康复治疗师强烈反对禁止MJH，分别需要薪资提高45.7%、20.0%和42.8%才会接受MJH禁令。提高公共部门薪资显著增加了公共部门的留用率。然而，非财务干预措施也具有影响力。医生、护士和康复治疗师分别愿意为改善临床实践环境放弃57.9%、54.8%和38.9%的薪资。有效的医院管理也很重要。存在一些偏好异质性。与其他两组相比，护士对某些属性的偏好存在显著差异，目前从事MJH的专业人员更强烈反对禁止MJH。
本研究提供了关于卫生专业人员对不同MJH规定偏好的新信息。它证实了非财务政策干预在解决MJH方面的重要性以及量身定制MJH政策设计的必要性。
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