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How to Attract Physicians to Underserved Areas? Policy Recommendations from a Structural Model

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  • Francisco Costa
  • Letícia Nunes
  • Fábio Sanches

Abstract

The lack of physicians in poorer areas is a matter of concern in developed and developing countries. This paper exploits location choices and individual characteristics of all generalist physicians who graduated in Brazil between 2001 and 2013 to study policies that aim at increasing the supply of physicians in underserved areas. We estimate physicians' locational preferences using a random coefficients discrete choice model. We find that physicians have substantial utility gains if they work close to the region they were born or from where they graduated. We show that wages and health infrastructure, though relevant, are not the main drivers of physicians' location choices. Simulations from the model indicate that quotas in medical schools for students born in underserved areas and the opening of vacancies in medical schools in deprived areas improve the spatial distribution of physicians at lower costs than financial incentives or investments in health infrastructure.
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  • Francisco Costa & Letícia Nunes & Fábio Sanches, 2019. "How to Attract Physicians to Underserved Areas? Policy Recommendations from a Structural Model," Working Papers 01, Instituto de Estudos para Políticas de Saúde.
    • Handle: RePEc:amc:wpaper:01
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    1. Fernanda Estevan & Thomas Gall & Louis-Philippe Morin, 2019. "Redistribution Without Distortion: Evidence from an Affirmative Action Programme at a Large Brazilian University," The Economic Journal, Royal Economic Society, vol. 129(619), pages 1182-1220.
    2. Badi H. Baltagi & Espen Bratberg & Tor Helge Holmås, 2005. "A panel data study of physicians' labor supply: the case of Norway," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1035-1045, October.
    3. John Kennan & James R. Walker, 2011. "The Effect of Expected Income on Individual Migration Decisions," Econometrica, Econometric Society, vol. 79(1), pages 211-251, January.
    4. Robert Summers, 1973. "International Price Comparisons Based Upon Incomplete Data," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 19(1), pages 1-16, March.
    5. David Albouy, 2009. "The Unequal Geographic Burden of Federal Taxation," Journal of Political Economy, University of Chicago Press, vol. 117(4), pages 635-667, August.
    6. David Neumark & Harry Holzer, 2000. "Assessing Affirmative Action," Journal of Economic Literature, American Economic Association, vol. 38(3), pages 483-568, September.
    7. Andreassen, Leif & Di Tommaso, Maria Laura & Strøm, Steinar, 2013. "Do medical doctors respond to economic incentives?," Journal of Health Economics, Elsevier, vol. 32(2), pages 392-409.
    8. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May.
    9. Bladimir Carrillo & Jose Feres, 2019. "Provider Supply, Utilization, and Infant Health: Evidence from a Physician Distribution Policy," American Economic Journal: Economic Policy, American Economic Association, vol. 11(3), pages 156-196, August.
    10. Steven Berry & James Levinsohn & Ariel Pakes, 2004. "Differentiated Products Demand Systems from a Combination of Micro and Macro Data: The New Car Market," Journal of Political Economy, University of Chicago Press, vol. 112(1), pages 68-105, February.
    11. Patrick Bayer & Robert McMillan & Alvin Murphy & Christopher Timmins, 2016. "A Dynamic Model of Demand for Houses and Neighborhoods," Econometrica, Econometric Society, vol. 84, pages 893-942, May.
    12. Esther W. de Bekker‐Grob & Mandy Ryan & Karen Gerard, 2012. "Discrete choice experiments in health economics: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 145-172, February.
    13. Heckman, James J. & Robb, Richard Jr., 1985. "Alternative methods for evaluating the impact of interventions : An overview," Journal of Econometrics, Elsevier, vol. 30(1-2), pages 239-267.
    14. Kelly C. Bishop & Alvin D. Murphy, 2011. "Estimating the Willingness to Pay to Avoid Violent Crime: A Dynamic Approach," American Economic Review, American Economic Association, vol. 101(3), pages 625-629, May.
    15. Jeffrey R Kling & Jeffrey B Liebman & Lawrence F Katz, 2007. "Experimental Analysis of Neighborhood Effects," Econometrica, Econometric Society, vol. 75(1), pages 83-119, January.
    16. Patrick Bayer & Fernando Ferreira & Robert McMillan, 2007. "A Unified Framework for Measuring Preferences for Schools and Neighborhoods," Journal of Political Economy, University of Chicago Press, vol. 115(4), pages 588-638, August.
    17. Nikhil Agarwal, 2015. "An Empirical Model of the Medical Match," American Economic Review, American Economic Association, vol. 105(7), pages 1939-1978, July.
    18. Peter Arcidiacono & Michael Lovenheim, 2016. "Affirmative Action and the Quality-Fit Trade-Off," Journal of Economic Literature, American Economic Association, vol. 54(1), pages 3-51, March.
    19. Ernesto Dal Bó & Frederico Finan & Martín A. Rossi, 2013. "Strengthening State Capabilities: The Role of Financial Incentives in the Call to Public Service," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 128(3), pages 1169-1218.
    20. Machado, Cecilia & Szerman, Christiane, 2016. "Centralized Admission and the Student-College Match," IZA Discussion Papers 10251, Institute of Labor Economics (IZA).
    21. Elias, P.E.M. & Cohn, A., 2003. "Health reform in Brazil: Lessons to consider," American Journal of Public Health, American Public Health Association, vol. 93(1), pages 44-48.
    22. Rebecca Diamond, 2016. "The Determinants and Welfare Implications of US Workers' Diverging Location Choices by Skill: 1980-2000," American Economic Review, American Economic Association, vol. 106(3), pages 479-524, March.
    23. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, vol. 14(4), pages 703-732, October.
    24. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    25. Erika Deserranno, 2019. "Financial Incentives as Signals: Experimental Evidence from the Recruitment of Village Promoters in Uganda," American Economic Journal: Applied Economics, American Economic Association, vol. 11(1), pages 277-317, January.
    26. Berry, Steven & Levinsohn, James & Pakes, Ariel, 1995. "Automobile Prices in Market Equilibrium," Econometrica, Econometric Society, vol. 63(4), pages 841-890, July.
    27. David Albouy & Bryan A. Stuart, 2020. "Urban Population And Amenities: The Neoclassical Model Of Location," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 61(1), pages 127-158, February.
    28. Fitzpatrick, Maria D. & Jones, Damon, 2016. "Post-baccalaureate migration and merit-based scholarships," Economics of Education Review, Elsevier, vol. 54(C), pages 155-172.
    29. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
    30. Holmes, George M., 2005. "Increasing physician supply in medically underserved areas," Labour Economics, Elsevier, vol. 12(5), pages 697-725, October.
    31. Bau,Natalie & Das,Jishnu, 2017. "The misallocation of pay and productivity in the public sector : evidence from the labor market for teachers," Policy Research Working Paper Series 8050, The World Bank.
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    Cited by:

    1. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    2. Natalia Nunes Ferreira‐Batista & Adriano Dutra Teixeira & Maria Dolores Montoya Diaz & Fernando Antonio Slaibe Postali & Rodrigo Moreno‐Serra & James Love‐Koh, 2023. "Is primary health care worth it in the long run? Evidence from Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1504-1524, July.
    3. Anikó Bíró & Blanka Imre, 2022. "Financial subsidies and the shortage of primary care physicians," CERS-IE WORKING PAPERS 2210, Institute of Economics, Centre for Economic and Regional Studies.

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    More about this item

    Keywords

    physician labor supply; recruiting; discrete choice model; revealed preferences;
    All these keywords.

    JEL classification:

    • E32 - Macroeconomics and Monetary Economics - - Prices, Business Fluctuations, and Cycles - - - Business Fluctuations; Cycles
    • R10 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - General Regional Economics - - - General

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