Improving Chinese primary care providers’ recruitment and retention: a discrete choice experiment

Song, Kuimeng; Scott, Anthony; Sivey, Peter; Meng, Qingyue

doi:10.1093/heapol/czt098

Cited by 56 publications

(72 citation statements)

References 25 publications

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“…Two of these studies also included online questionnaires [51, 70], although three studies used computer-assisted surveys on student populations in LMIC [45, 56, 77]. In LMIC, response rates were generally very high, with a mean of 83.2% (range 65.2% to 100%, the latter from a study set in China as reported by authors [60]), compared to 49.3% (16.8 – 65.0%) in HICs. Unsurprisingly, response rates were significantly lower for graduates (mean of 62.7%, range 16.8 – 100%) than for students (mean 84.1%, range 62.7 – 100%), underscoring the potential for distortion if results from these two subgroups are combined.…”

Section: Resultsmentioning

confidence: 99%

The use of discrete choice experiments to inform health workforce policy: a systematic review

Mandeville

Lagarde

Hanson

2014

BMC Health Serv Res

119

124

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BackgroundDiscrete choice experiments have become a popular study design to study the labour market preferences of health workers. Discrete choice experiments in health, however, have been criticised for lagging behind best practice and there are specific methodological considerations for those focused on job choices. We performed a systematic review of the application of discrete choice experiments to inform health workforce policy.MethodsWe searched for discrete choice experiments that examined the labour market preferences of health workers, including doctors, nurses, allied health professionals, mid-level and community health workers. We searched Medline, Embase, Global Health, other databases and grey literature repositories with no limits on date or language and contacted 44 experts. Features of choice task and experimental design, conduct and analysis of included studies were assessed against best practice. An assessment of validity was undertaken for all studies, with a comparison of results from those with low risk of bias and a similar objective and context.ResultsTwenty-seven studies were included, with over half set in low- and middle-income countries. There were more studies published in the last four years than the previous ten years. Doctors or medical students were the most studied cadre. Studies frequently pooled results from heterogeneous subgroups or extrapolated these results to the general population. Only one third of studies included an opt-out option, despite all health workers having the option to exit the labour market. Just five studies combined results with cost data to assess the cost effectiveness of various policy options. Comparison of results from similar studies broadly showed the importance of bonus payments and postgraduate training opportunities and the unpopularity of time commitments for the uptake of rural posts.ConclusionsThis is the first systematic review of discrete choice experiments in human resources for health. We identified specific issues relating to this application of which practitioners should be aware to ensure robust results. In particular, there is a need for more defined target populations and increased synthesis with cost data. Research on a wider range of health workers and the generalisability of results would be welcome to better inform policy.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-367) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The use of discrete choice experiments to inform health workforce policy: a systematic review

Mandeville

Lagarde

Hanson

2014

BMC Health Serv Res

119

124

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“…Studies have identified that positive workplace experiences, working conditions, geographical location, personal factors such as proximity to family or friends 1‐4 and high‐quality working culture can influence speciality or job choice 3 and intentions to stay or quit medical training in medical graduates 1,5‐11 …”

Section: Introductionmentioning

confidence: 99%

Today's doctors: What do men and women value in a training post?

et al. 2020

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Objectives: Recent studies suggest that traditional male-female differences may be changing in terms of what is valued in a medical career but there have been no studies directly quantifying the relationship between gender and stated career-related preferences. To address this gap, we examined the differences between male and female doctors in terms of the strength of their work-related preferences at the point of eligibility to enter residency or specialty training in the UK. Methods:This was a quantitative study using a survey incorporating a discrete choice experiment (DCE). Respondents were asked a series of questions in which they had to choose between two or more scenarios, differing in terms of attributes. The attributes were: location; familiarity with specialty; culture of the working and learning environment; earnings; working conditions, and opportunities for professional development. The main outcome measure was willingness to accept compensation to forgo a desirable attribute within a training position. Conditional logistic regression models were run separately for males and females. Results:A total of 5005 out of 6890 (73%) Foundation Year 2 doctors completed the DCE. The relative value of each attribute was similar for males and females, with location most valued and familiarity with the specialty least valued. There was a pattern of female respondents valuing the move between the best and worst levels of each training attribute more than men, and significantly more than men in respect of the importance of working culture. Conclusions:This study adds to existing knowledge in terms of quantifying gendered values in respect of training or residency preferences. That men value a supportive working culture significantly less than women is well established. However, our findings that location, working conditions and working culture are increasingly important to both men and women, suggests that traditional gender norms may be changing.This intelligence can inform gender-responsive workforce planning and innovation, and future research. | 409 SCANLAN et AL.

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“…Several studies have highlighted the poor quality of primary care services in rural areas of China. One recent study found that most general practitioners working in primary health facilities do not have college education experience and had received only 2-3 years of medical training in China [42]. Another study employing standardized patients found that general practitioners working at village clinics were able to correctly treat presumptive cases of angina 61.00% of the time and dysentery 45.00% of the time [43].…”

Section: Discussionmentioning

confidence: 99%

Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment

Wang

Liu

et al. 2020

Preprint

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Abstract Background: Preliminary evaluations have found that family doctor contract services (FDCSs) have significantly controlled medical expenses, better managed chronic diseases, and increased patient satisfaction and service compliance. In 2016, China proposed the establishment of a family doctor system to carry out contract services, but studies have found the uptake and utilization of these services to be limited. This study aimed to investigate rural residents’ preferences for FDCSs from the perspective of the Chinese public.Methods: A discrete choice experiment (DCE) was performed to elicit the preferences for FDCSs among rural residents in China. Attributes and levels were established based on a literature review and qualitative methods. Five attributes, i.e., cost, medicine availability, the reimbursement rate, family doctor competence, and family doctor attitude, were evaluated using a mixed logit model.Results: A total of 609 residents were included in the main DCE analysis. The respondents valued the high competence (coefficient 2.44, [SE 0.13]) and the good attitude (coefficient 1.42, [SE 0.09]) of family doctors the most. Cost was negatively valued (coefficient -0.01, [SE 0.01]), as expected. Preference heterogeneity analysis was conducted after adjusting the interaction terms, and we found that rural residents with higher educational attainment prefer a good attitude more than their counterparts with lower educational attainment. The estimated willingness to pay (WTP) for “high” relative to “low” competence was 441.13 RMB/year, and the WTP for a provider with a “good” attitude relative to a “poor” attitude was 255.77 RMB/year. Conclusion: The present study suggests that strengthening and improving the quality of primary health care, including the competence and attitudes of family doctors, should be prioritized to increase the uptake of FDCSs. The contract service package, including the annual cost, the insurance reimbursement rate and individualized services, should be redesigned to be congruent with residents having different health statuses and their stated preferences.

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Improving Chinese primary care providers’ recruitment and retention: a discrete choice experiment

Cited by 56 publications

References 25 publications

The use of discrete choice experiments to inform health workforce policy: a systematic review

The use of discrete choice experiments to inform health workforce policy: a systematic review

Today's doctors: What do men and women value in a training post?

Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment

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