Effectiveness analysis of different incentive strategies in attracting doctors′ transition to primary health institutions based on Markov model
10.3760/cma.j.cn111325-20241108-00943
- VernacularTitle:基于Markov模型的不同激励策略吸引医生到基层工作的效果分析
- Author:
Tianyue ZHANG
1
;
Ruikang ZHANG
;
Shen LI
;
Min LI
;
Dan HU
Author Information
1. 南京医科大学医政学院，南京 211166
- Publication Type:Journal Article
- Keywords:
Incentive;
Primary health institution;
Health workforce;
Personnel turnover;
Markov model
- From:
Chinese Journal of Hospital Administration
2025;41(7):558-565
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the short-term and long-term effects of different incentive strategies on attracting physicians from secondary and higher-level hospitals to work in primary health institutions, and to analyze the influencing factors in depth.Methods:Based on the preference probabilities of physicians from secondary and higher-level hospitals to work in primary health institutions, as measured by a discrete choice experiment model, a Markov model was constructed to simulate physician mobility between different types of health institutions. The model was used to assess the long-term attractiveness of various intervention strategies and to identify key factors affecting physicians′ decisions to work in primary health institutions.Results:Increasing salary by 10% and providing permanent positions (bianzhi) were found to be the most effective strategies for attracting physicians from secondary and higher-level hospitals to primary health institutions, increasing physicians′ preference probabilities by 54.5% and 58.5%, respectively. The 20-year Markov model simulation of physician mobility showed that, without intervention, the number of physicians in primary health institutions would decline from 171 to 33, while the gap with secondary and higher-level hospitals would continue to widen. Simulations examining the effects of different job attributes revealed that 9 factors, including working in township hospitals or community health service centers, maintaining or increasing current salary, having record-based tenure or bianzhi, working 40-60 hours or>40 h per week, and receiving higher local recognition and respect, could effectively attract physicians to primary health institutions. Among these, a 10% salary increase and bianzhi provision could increase the number of physicians in primary institutions to 361 and 364, respectively. Moreover, greater local recognition and respect for physicians could help sustain long-term growth in the number of primary healthcare physicians.Conclusions:Strategies of increasing annual salary and offering bianzhi can effectively attract a large number of high-quality physicians to primary health institutions in the short term; however, their effectiveness gradually diminishes over time. To achieve sustainable long-term in the number of physicians in primary health institutions, further research is needed to evaluate the effectiveness of other incentive strategies and to develop a comprehensive incentive strategy combination.
