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Financial incentives for return of service in underserved areas: a systematic review

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  • David E. Bloom

    ()
    (Harvard School of Public Health)

  • Till Barnighausen

    ()
    (Harvard School of Public Health)

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    Abstract

    Of the 42 reviewed studies 33 investigated financial-incentive programs in the US. The remaining studies evaluated programs in Japan (five studies), Canada (two), New Zealand (one) and South Africa (one). The programs started between 1930 and 1998. We identified five different types of programs (service-requiring scholarships, educational loans with service requirements, service-option educational loans, loan repayment programs, and direct financial incentives). Financial incentives ranged from year-2000 United States dollars 1,358 to 28,470. All reviewed studies were observational. The random-effects estimate of the pooled proportion of all eligible program participants who had either fulfilled their obligation or were fulfilling it at the time of the study was 71% (95% confidence interval 60-80%). Seven studies compared retention in the same underserved area between program participants and non-participants. Six studies found that participants were less likely to remain in the same underserved area (five studies reported the difference to be statistically significant, while one study did not report a significance level); one study did not find a significant difference in retention in the same area. Twelve studies compared provision of care/retention in any underserved area between participants and non-participants. Ten studies found that participants were more likely to continue to practice in any underserved area (eight studies reported the difference to be statistically significant, while two studies did not provide the results of significance tests); two studies found that program participants were significantly less likely than non-participants to remain in any underserved area. Seven studies investigated the satisfaction of participants with aspects of their enrolment in financial-incentive programs; three studies examined the satisfaction of members of participants’ families with their lives in the undeserved area.

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    File URL: http://www.hsph.harvard.edu/pgda/WorkingPapers/2009/PGDA_WP_43.pdf
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    Bibliographic Info

    Paper provided by Program on the Global Demography of Aging in its series PGDA Working Papers with number 4309.

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    Date of creation: Jun 2009
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    Handle: RePEc:gdm:wpaper:4309

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    Web page: http://www.hsph.harvard.edu/pgda
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    Related research

    Keywords: Financial incentives; underserved areas; review;

    This paper has been announced in the following NEP Reports:

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    Cited by:
    1. Till Bärnighausen & David E. Bloom & Salal Humair, 2009. "A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment," NBER Working Papers 15517, National Bureau of Economic Research, Inc.
    2. Scott, Anthony & Witt, Julia & Humphreys, John & Joyce, Catherine & Kalb, Guyonne & Jeon, Sung-Hee & McGrail, Matthew, 2013. "Getting doctors into the bush: General Practitioners' preferences for rural location," Social Science & Medicine, Elsevier, vol. 96(C), pages 33-44.
    3. Johns, Benjamin & Steinhardt, Laura & Walker, Damian G. & Peters, David H. & Bishai, David, 2013. "Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: A seemingly unrelated regression approach," Social Science & Medicine, Elsevier, vol. 89(C), pages 25-31.
    4. McGrail, Matthew R. & Humphreys, John S. & Joyce, Catherine M. & Scott, Anthony, 2012. "International medical graduates mandated to practise in rural Australia are highly unsatisfied: Results from a national survey of doctors," Health Policy, Elsevier, vol. 108(2), pages 133-139.
    5. Till Bärnighausen & David E. Bloom & Salal Humair, 2009. "A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment," PGDA Working Papers 5209, Program on the Global Demography of Aging.

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