Effect of doctor allocation policies on the equitable distribution of doctors in Thailand

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

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.

Equity and trends in the allocation of health human resources in China from 2012 to 2021

BACKGROUND

As the second most populous country in the world, China has a huge demand for health human resources. Over the past decade, the Chinese government has continuously increased investment in the health sector and implemented relevant policies and systems in an attempt to enhance the overall quantity and equity of health human resources. This study aims to analyze the equity and developmental trends in the allocation of health human resources in China from 2012 to 2021, providing reference and theoretical support for the government's further optimization of health human resources allocation.

METHODS

This study collected health human resources data from 31 provinces, municipalities, and autonomous regions in China from 2012 to 2021. The methods employed included Lorenz curves, Gini coefficients, and agglomeration degree analysis, which examined the developmental trends and equity of health human resources from the perspectives of population and geographical.

RESULTS

This study found that over the past decade, there has been a significant increase in the total quantity of health human resources in China, accompanied by an improvement in equity, although disparities still exist. There are notable variations in the distribution of health human resources based on geographical area, with disparities between different regions. Relative shortages of health human resources are observed in western regions, while some areas in the eastern and central regions exhibit an abundance or surplus of health human resources.

CONCLUSION

Overall, health human resources in China have experienced stable development, with an incremental improvement in allocation equity, yet there remains considerable room for progress. It is imperative to continue strengthening policy guidance and regulation to facilitate the rational flow of health human resources, narrow regional disparities, and achieve the goal of universal health coverage.

Impact of in-service training on the knowledge, attitude, and practice of pharmacovigilance in Malawi: a cross-sectional mixed methods study

Background

Spontaneous reporting of adverse drug reaction (ADRs) is low in Malawi. We assessed the impact of training intervention on knowledge, attitudes, and practices of health care professionals (HCPs) in pharmacovigilance (PV).

Methods

We employed a mixed-methods study design. A questionnaire was administered among HCPs who were trained in PV, followed by face-face interviews. We further extracted individual case safety reports which were submitted to the local databasewithin a period of six months prior and after the PV training. Quantitative data was analyzed using STATA 14.1. Paired t-test was used to assess the differences in PV knowledge among HCPs before and after the training. For qualitative data, we manually derived key themes from the participant's responses.

Results

Overall, the mean knowledge score was significantly improved across all the participants from a mean of 56% (95% CI 53% to 58%) to 66% (95% CI 64% to 69%) after the training, p< 0.001. There was a 2.8-fold increase in the number of participants who were able to detect an ADR after the training and a 1.8-fold increase in the percentage of reporting the detected ADRs after the training. Participants expressed preference of a paper-based reporting system to other reporting tools. However, they outlined several challenges to the system which discourages HCPs from reporting ADRs, such as lack of feedback, unavailability of reporting forms and delay to transmit data to the national centre.

Conclusion

The survey found that in-service training for HCPs improves KAP of PV and reporting rates of ADRs. We recommend widening of the training and introducing PV courses in undergraduate programs for health care workers in Malawi.

An integrative review of the impact of allied health student placements on current staff's knowledge and procedural skills in acute and primary care settings

BACKGROUND

Staff shortages limit access to health services. The bidirectional benefits of allied health clinical placements are understood in the domains of student learning, health service delivery, and future workforce development. Still, the benefits to current workforce outcomes remain unknown. This review provides insights into the effects of allied health student placements in acute and primary care settings, particularly on healthcare staff's knowledge and procedural skills.

METHODS

This search was based on the integrative review process established by Whittemore and Knafl in 2005. In October 2023, the first author (MH) searched five major electronic databases: Medline-EBSCO, PubMed, CINAHL, Embase, and Scopus. The CLUSTER model was used to track additional references. The first three authors (MH, SM, and SC) were involved in screening, quality appraisal, and synthesis of the studies. Data were thematically synthesised and analysed.

RESULTS

MeSH headings and keywords were used in key search areas: health education, health professional training, clinical placements, and allied health professions. The systematic search yielded 12 papers on allied health student placements across various healthcare settings in rural and metropolitan areas, with no high-quality methodologies measuring student placements' impact on staff knowledge and skills. Four main themes were identified from the analysis: meaningful student integration in service delivery, targeted educational support to healthcare staff, development of staff procedural skills and confidence, and the mechanisms of why student placements work in this aspect.

CONCLUSIONS

This review suggests that offering allied health student placement could be a promising approach to supporting rural healthcare staff in performing patient assessments and treatments proficiently and collaboratively. However, this requires further investigation to confirm.

Practice Consolidation Among US Medical Oncologists, 2015-2022

PURPOSE

Health care consolidation has significantly affected cancer care delivery, with oncology practices undergoing substantial consolidation over the past two decades. This study investigates practice consolidation trends among medical oncologists (MOs), factors associated with consolidation, and changes in MO geographic distribution.

METHODS

Medicare data from 2015 to 2022 were used to assess MO practice consolidation in hospital referral regions (HRRs), linked with regional health care market data and physician demographics. The Herfindahl-Hirschman Index (HHI) was used to measure consolidation, and the Gini coefficient was used to measure MO distribution across counties. Multivariable linear regression explored factors associated with MO practice consolidation.

RESULTS

Between 2015 and 2022, the number of MOs increased by 14.5% (11,727-13,433), whereas the number of MO practices decreased by 18.0% (2,774-2,276). The mean number of MOs per practice increased by 40% (4.26-5.95; P < .001). The percentage of MOs in small practices decreased, whereas larger practices saw an increase. MO consolidation, as indicated by the HHI, increased by 9% (median HHI, 0.3204-0.3480). HRRs with higher baseline hospital consolidation and more hospital beds per capita were more likely to have MO practice consolidation. Despite MO practice consolidation, the county-level distribution of MOs did not change substantially.

CONCLUSION

On the basis of Federal Trade Commission classifications, MO practices were highly concentrated in 2015 and consolidated even further by 2022. While distribution of MOs at the county level remained stable, further research is needed to assess the effects of rapid consolidation on cancer care cost, quality, and access. These data have important implications for policymakers and payers as they design programs that ensure high-quality, affordable cancer care.

Factors associated with regional retention of physicians: a cross-sectional online survey of medical students and graduates in Japan

BACKGROUND

Physician shortage and maldistribution is an urgent health policy issue requiring resolution. Determination of factors associated with regional retention and development of effective policy interventions will help to solve this issue. The purpose of the present study was to identify factors associated with regional retention and discuss their policy implications.

METHODS

We conducted a cross-sectional online survey from February to March of 2022 for graduates from regional quotas (special quotas for medical schools to select students engaged in community medicine) and Jichi Medical University (JMU) and students at 10 medical schools including JMU. Completed surveys were obtained from 375 graduates and 1153 students. Questions included intention to continue to work in their home prefecture in the future, as well as background information and potential factors associated with regional retention. In the analyses, regional quotas and JMU were referred to as community medicine-oriented programs and schools (CMPS). We performed logistic regression analyses to identify factors associated with regional retention.

RESULTS

Among the students, scholarship-bonded obligatory service, satisfaction with current life, intention to belong to ikyoku (a traditional physician allocation/training system in Japanese medical schools), and interest in general practice/family medicine were significantly positively associated with regional retention. Among the graduates, satisfaction with training environment, intention to belong to ikyoku, and recommending their program to high school students were significantly positively associated with regional retention. For students of CMPS, satisfaction with the career development program was positively associated with future regional retention. For graduates, this association was observed only in the crude analysis.

CONCLUSIONS

In addition to known factors such as interest in general practice/family medicine, intention to belong to ikyoku had a substantial impact on regional retention. The present results suggest that the career support system represented by ikyoku as well as a career development program are of potential importance for increasing regional retention through the mechanisms of a sense of belonging and a life-long education system. These findings provide useful information for the development of further policy interventions that interweave traditional and new systems to maximize their effectiveness.