基于离散选择实验的乡镇卫生院和村卫生室医生工作选择偏好比较研究

Comparative Study of Job Choice Preferences on Doctors in Township Health Centers and Village Clinics Based on Discrete Choice Experiments

目的:比较乡镇卫生院和村卫生室医生工作选择偏好,为吸引和稳定农村基层医生队伍提供参考。方法:基于离散选择实验,确定月收入水平等6项属性及其水平,采用部分析因设计方法设计问卷。选取乡镇卫生院和村卫生室的在岗医生进行问卷调查,共收集有效问卷390份,运用混合logit模型、支付意愿法等方法进行分析。结果:人员编制(β=2.089)、月收入水平(β=1.043)、福利保障状况(β=0.707)对乡镇卫生院医生工作选择偏好的影响位列前3,对村卫生室医生工作选择偏好影响较大的因素是人员编制(β=2.087)、福利保障状况(β=1.312)和月收入水平(β=1.041),职称晋升年限和工作条件对村卫生室医生工作选择偏好的影响没有统计学意义。工作属性的改变对工作选择的边际效应有不同程度影响。结论:人员编制是乡镇卫生院和村卫生室医生最关注的工作属性,经济因素和非经济因素对农村基层医生工作选择偏好产生重要影响,应盘活用好县域编制资源,因人因地施策,制定结合多种影响因素的政策干预包。

Objective:To compare the job choice preferences of doctors in township health centers and village clinics,so as to provide a reference for attracting and stabilizing the rural primary care workforce.Methods:Based on discrete choice experiments,six attributes and levels such as monthly income level were determined,and questionnaires were designed using the departmental analysis factor design method.The questionnaire survey was conducted by selecting doctors on duty in township health centers and village clinics,and a total of 390 valid questionnaires were collected and analyzed by using mixed logit models and willingness to pay.Results:Staff quota(β=2.089),monthly income level(β=1.043),and welfare protection status(β=0.707)ranked in the top three in terms of their impact on the job choice preferences of doctors in township health centers.The factors that had a greater impact on the job choice preferences of doctors in village clinics were staff quota(β=2.087),welfare protection status(β=1.312)and monthly income level(β=1.041),while the effects of years of title promotion and working conditions on the job choice preferences of doctors in village clinics were not statistically significant.Changes in job attributes had different degrees of marginal effects on job choice.Conclusion:The staff quota is the most important job attribute of concern for doctors in township health centers and village clinics.Both economic and non-economic factors have important effects on the job choice preferences of rural grassroots doctors,and policy intervention packages that combine multiple influencing factors should be developed by making good use of county staffing resources,tailoring policies to individual and local conditions.