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Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

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  • J Jaime Miranda
  • Francisco Diez-Canseco
  • Claudia Lema
  • Andrés G Lescano
  • Mylene Lagarde
  • Duane Blaauw
  • Luis Huicho

Abstract

Background: Doctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs. Methods and Findings: A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. Conclusions: Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.

Suggested Citation

  • J Jaime Miranda & Francisco Diez-Canseco & Claudia Lema & Andrés G Lescano & Mylene Lagarde & Duane Blaauw & Luis Huicho, 2012. "Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-9, December.
  • Handle: RePEc:plo:pone00:0050567
    DOI: 10.1371/journal.pone.0050567
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    References listed on IDEAS

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    1. Angelica Sousa & Mario R Dal Poz & Cristiana Leite Carvalho, 2012. "Monitoring Inequalities in the Health Workforce: The Case Study of Brazil 1991–2005," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-7, March.
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    1. Ogonna N O Nwankwo & Chukwuebuka I Ugwu & Grace I Nwankwo & Michael A Akpoke & Collins Anyigor & Uzoma Obi-Nwankwo & Sunday Andrew Jr. & Kelechukwu Nwogu & Neil Spicer, 2022. "A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria," PLOS ONE, Public Library of Science, vol. 17(3), pages 1-17, March.
    2. Krishna D Rao & Mandy Ryan & Zubin Shroff & Marko Vujicic & Sudha Ramani & Peter Berman, 2013. "Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-9, December.
    3. Gareth H Rees & Felipe Peralta Quispe & Cris Scotter, 2021. "The implications of COVID‐19 for health workforce planning and policy: the case of Peru," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(S1), pages 190-197, May.
    4. Weituschat, Chiara Sophia & Pascucci, Stefano & Materia, Valentina Cristiana & Caracciolo, Francesco, 2023. "Can contract farming support sustainable intensification in agri-food value chains?," Ecological Economics, Elsevier, vol. 211(C).
    5. Na-na Wang & Liang-guo Luo & Ya-ru Pan & Xue-mei Ni, 2019. "Use of discrete choice experiments to facilitate design of effective environmentally friendly agricultural policies," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 21(4), pages 1543-1559, August.

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