Job incentives influencing health professionals working in rural and remote areas in Thailand: finding from discrete choice experiment to policy recommendation.

Abstract

Background: This research aims to understand job incentives of health professionals who work in rural and remote areas, which could lead to the further development of policy proposals.

Methods: The study design has been applied discrete choice experiment (DCE) to determine attribute preferences of: 1) doctors, dentists, and pharmacists, and 2) nurses and interdisciplinary teams. Four areas in northern Thailand were purposively selected. To determine the attributes and levels, a qualitative method was employed. An orthogonal array was adopted to produce 16 options for categorizing the employment preferences of each person. Conditional and mixed logit regressions were used to examine the major incentives influencing health workforce decision-making. In addition, willingness to pay (WTP) analysis according to beta coefficients from the regression models was performed.

Results: The total number of participants in the first group was 34, and the latter group included 160 participants. Financial incentives, suitable accommodation, workload and job post in hometown were all significant criteria for both groups. Surprisingly, opportunity to continue study was not a significant consideration for doctors, dentists, or pharmacists to work in remote areas. When getting a 40% higher income than counterparts working in public hospitals in urban regions, the decision-making level among doctors, dentists and pharmacists influenced decisions by 4.2 times, while nurses and interdisciplinary teams were influenced twice as much. Regarding the WTP analysis, doctors, pharmacists, and dentists were willing to receive 8,126 (95% CI: 3,477; 15,442) Baht per month, and nurses and interdisciplinary teams were willing to receive 7,733 (95% CI: 4,926; 11,502) Baht per month to work more than 48 h per week. The results of mixed and conditional logit models were found consistently.

Conclusion: Financial subsidies for all types of healthcare workers in rural and remote areas remain effective policies and need to be maintained. It is not merely a matter of national policy; hospital-level policies can change and contribute to resolving the problem of health personnel shortages. The short-term plan for retaining health staff would be to provide suitable, safe, and satisfying accommodations.