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What do doctors want? developing incentives for doctors to serve in Indonesia's rural and remote areas

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  • Chomitz, Kenneth M.
  • Setiadi, Gunawan
  • Azwar, Azrul
  • Ismail, Nusye
  • Widiyarti

Abstract

Like many large countries, Indonesia has difficulty attracting doctors to service in rural and remote areas. To guide the creation of incentives for service in these areas, the authors analyze two sets of data about physicians: 1) the locations chosen by graduating medical students before and after a major change in the incentive system, and 2) survey data on choices among hypothetical assignments differing in compensation, career prospects, and amenities at various locations. Their findings suggest that: a) The current policy of offering specialist training is incentive enough to make doctors from Java willing to serve in remote areas. (It is not necessary to also offer a civil service appointment.) But providing specialist training as an incentive to work in remote areas is not only expensive, but potentially inefficient, since specialist practice and rural public health management require different skills and attitudes. b) Moderately (but not extremely) remote areas can be staffed using modest cash incentives. c) Doctors from the Outer Islands are far more willing to serve in remote areas than their counterparts from Java. So, it may be worthwhile increasing the representation of Outer Island students in medical schools (perhaps through scholarships and assistance in pre-university preparation).

Suggested Citation

  • Chomitz, Kenneth M. & Setiadi, Gunawan & Azwar, Azrul & Ismail, Nusye & Widiyarti, 1998. "What do doctors want? developing incentives for doctors to serve in Indonesia's rural and remote areas," Policy Research Working Paper Series 1888, The World Bank.
  • Handle: RePEc:wbk:wbrwps:1888
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    References listed on IDEAS

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    Cited by:

    1. Vujicic, Marko & Shengelia, Bakhuti & Alfano, Marco & Thu, Ha Bui, 2011. "Physician shortages in rural Vietnam: Using a labor market approach to inform policy," Social Science & Medicine, Elsevier, vol. 73(7), pages 970-977.
    2. Julie Riise Kolstad, 2011. "How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 196-211, February.
    3. World Bank, 2006. "Poverty, Growth, and Environment in Brazil : Spatial Insights for Policymaking," World Bank Publications - Reports 12852, The World Bank Group.
    4. Isabel Correia & Paula Veiga, 2010. "Geographic distribution of physicians in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 383-393, August.
    5. Giles, John & Satriawan, Elan, 2015. "Protecting child nutritional status in the aftermath of a financial crisis: Evidence from Indonesia," Journal of Development Economics, Elsevier, vol. 114(C), pages 97-106.
    6. Ian Anderson & Andreasta Meliala & Puti Marzoeki & Edo Pambudi, 2014. "The Production, Distribution, and Performance of Physicians, Nurses, and Midwives in Indonesia: An Update," Health, Nutrition and Population (HNP) Discussion Paper Series 91324, The World Bank.
    7. 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.
    8. Serneels, Pieter & Lindelow, Magnus & Garcia-Montalvo, Jose & Barr, Abigail, 2005. "For public service or money : understanding geographical imbalances in the health workforce," Policy Research Working Paper Series 3686, The World Bank.
    9. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank.
    10. Heather Klemick & Kenneth L. Leonard & Melkiory C. Masatu, 2007. "Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 91(2), pages 347-358.
    11. Pieter Serneels & Magnus Lindelow & José Garcia Montalvo & Abigail Barr, 2006. "For public service or money: Understanding geographical imbalances in the health workforce in Ethiopia," Economics Working Papers 989, Department of Economics and Business, Universitat Pompeu Fabra.
    12. Li, Jinhu & Scott, Anthony & McGrail, Matthew & Humphreys, John & Witt, Julia, 2014. "Retaining rural doctors: Doctors' preferences for rural medical workforce incentives," Social Science & Medicine, Elsevier, vol. 121(C), pages 56-64.
    13. Aly Diana & Samantha A. Hollingworth & Geoffrey C. Marks, 2015. "Effects of decentralisation and health system reform on health workforce and quality-of-care in Indonesia, 1993–2007," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(1), pages 16-30, January.
    14. Mu, Chunzhou, 2015. "The age profile of the location decision of Australian general practitioners," Social Science & Medicine, Elsevier, vol. 142(C), pages 183-193.
    15. World Bank, 2003. "Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 1. Main Report," World Bank Publications - Reports 14824, The World Bank Group.
    16. Hammer, Jeffrey & Jack, William, 2002. "Designing incentives for rural health care providers in developing countries," Journal of Development Economics, Elsevier, vol. 69(1), pages 297-303, October.
    17. Gauri, Varun, 2001. "Are incentives everything? payment mechanisms for health care providers in developing countries," Policy Research Working Paper Series 2624, The World Bank.
    18. Sandra Nocera & Gabrielle Wanzenried, 2002. "On the Dynamics of Physician Density; Theory and Empirical Evidence for Switzerland," Diskussionsschriften dp0208, Universitaet Bern, Departement Volkswirtschaft.

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