Job preferences for healthcare administration students in China: A discrete choice experiment

Abstract

BackgroundThere is a deficiency of healthcare administrators in China as compared with other countries; furthermore, the distribution is unequal. To inform an effective policy intervention, it is crucial to understand healthcare administration students’ career decision-making. This study aims to investigate the undergraduate students’ stated preferences when choosing a job.MethodsA discrete choice experiment (DCE) was conducted among a population-based multistage sample of 668 final year undergraduate healthcare administration students during April to June 2017 in eight universities of China to elicit their job preferences. Attributes include location, monthly income, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), training and career development opportunity, working environment and workload. Conditional and mixed logit models were used to analyze the relative importance of job attributes.ResultsAll six attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income, workload and working environment were of most concern to healthcare administration students when deciding their future. Among the presented attributes bianzhi was of the least concern. Sub-group analysis showed that students who have an urban background and/or with higher annual family incomes were willing to pay more for working in the city. In addition, students from western and middle universities valued bianzhi higher than students from eastern universities.ConclusionsThis is the first study focusing on the career decision-making of Chinese healthcare administration students at a critical career decision-making point. Both monetary and non-monetary interventions could be considered by policy-makers to attract students to work in health institutions, especially in rural and remote health institutions in China. There exists preference heterogeneity on healthcare administration students’ job preferences, which should also be taken into account in developing more effective policy incentive packages.

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

“…Many included studies (39%) did not provide a definition of rural. Many (39%) also defined ‘rural’ based on non-facility aspects such as level of socioeconomic deprivation [ 32 , 51 , 53 , 57 , 62 , 70 , 86 , 90 , 91 ], being located outside of metropolitan areas [ 26 – 29 , 48 , 82 ], population size [ 42 , 65 ], administrative unit definitions [ 36 , 77 , 84 ], and geographical access [ 50 , 52 , 56 , 58 , 83 ]. Some (14%) studies defined rural as working in primary care or community-level facilities or smaller hospitals [ 31 , 47 , 49 , 61 , 63 , 64 , 67 , 95 ].…”

“…A broad range of educational factors were associated with rural work, especially related to rural background. Both preference and actual work in rural locations were associated with having resided in rural areas during the school-age period, having graduated from a rurally located high school, or being a native of a particular (1) had no definition of rural or no description of the place characteristics where the study was done and this was not cross-referenced to an earlier study by the authors [66, 68, 69, 74-76, 78, 81, 92], or; (2) relied on respondents' own definition of rural [33-35, 37, 39, 40, 43-45, 54, 55, 73, 79, 80, 88, 89, 93, 94, 98] Facility-related Type of health facility 9 1 0 10 (14.1) Township-village health center [47,95], county or township hospital [61], community or primary or additional primary health centers, secondary hospital [67], community hospital [31,49], government rural health unit [63,64] Non-facility related Population size 2 0 0 2 (2.8) City/municipality with less than 100,000 population [65], district with < 25,000 population [42] Non-metropolitan 6 0 0 6 (8.5) Area outside the country capital and/or large city [26-29, 48, 82] Administrative unit 3 0 0 3 (4.2) Any area of county, town or village [36]; rural or farther rural [84]; township or rural county [77] One of the most rural regions in a country 2 4 4 10 (14.1) Rural relative to other areas in the country, such as: Kampong Chhnang in Cambodia, Guangxi in China [32]; Bac Giang, Lao Cai and Thai Binh in Vietnam [32,70]; Chattisgarh and Odisha in India [53,57,86,91], East Nusa Tenggara in Indonesia and Zamboanga in the Philippines [32,51,53,57,62,70,86,90] Access and/or topography 2 3 0 5 (7.0) Limited c...…”

“…We identified that male students or doctors were more likely to prefer or actually work in rural or remote locations [ 27 , 29 , 38 , 43 , 47 , 77 ] and female doctors were more affected by perceptions of lack of security than were male doctors [ 57 , 83 ]. Since women dominate the doctor population in many Asia-Pacific LMICs [ 38 , 48 , 58 , 76 , 108 ], understanding the environmental and personal attributes that influence female doctors’ willingness to work rurally is crucial to inform effective policy.…”

“…Connection and the absence of language barrier with community [83], or community appreciation, growth and support [72], was important attributes in attracting doctors to work or remain in rural locations Community appreciation, literacy, attitude to western medicine have been mentioned as one of factors motivated doctors and students to work in rural locations [39,41,79,89] i) Career stages ‡ Although the definition is unclear, support from local government was among the most selected attributes influencing rural work preferences of medical students [75] and intention for rural retention among doctors [80,85] k) Gender ‡ There is evidence that male are more likely to working in rural areas [27,29] Half of the studies investigating gender (n = 16) found no difference in rural preference between male and female [33, 34, 36, 39-42, 44-46, 48, 49, 55, 56, 91, 93]. While some studies found that, after adjusting for other variables, being male was strongly associated with preference to work in rural areas [43,47,77], several other studies found the opposite [35,37]. Some DCE studies also found that males and females value job attributes differently: males are more responsive to workplaces near their home province and salary increases [54,58], while females value housing more highly [58,74] While one study found a weak association between being unmarried and willingness to take a rural job [45], most found no difference in rural preference or work according to marital status [33,34,39,44,88,91] E. Health systems ‡ a) Governance ‡ This refers to any aspect related to leadership and governance beyond the health facility Political favoritism was shown to interfere with ...…”

Job Preferences for Social Medicine and Health care Management PhD Students in China: A Discrete Choice Experiment

“…We used qualitative research as well as a literature review to select attributes to be included in the DCE. Initially, ten attributes commonly adopted and suitable for the Chinese health system were identified through our previous research experience [13] and a literature review [14][15][16] , which were monthly income, Bianzhi, location, housing, children's education, working environment, career promotion, workload, management style, training and career development opportunity. An in-depth interview was then conducted with 7 SMHCM PhD students from Fudan university and Shandong University, which suggested that the attribute of management style and workload could be removed.…”