离散选择实验在卫生人力资源领域的应用进展

doi:10.12114/j.issn.1007-9572.2022.0664

摘要/Abstract

摘要： 背景运用离散选择实验（DCE）对卫生人员工作选择倾向性进行研究，可以为制定农村及偏远地区吸引和留用卫生人员相关政策提供科学且有效的依据。目的对DCE应用于卫生人力资源领域的研究进行梳理、总结和归纳，以期为将来的相关研究提供参考。方法于2022年2—4月，系统检索Web of Science、PubMed、中国知网、万方数据知识服务平台、维普网中与DCE应用于卫生人力资源领域相关的文献。提取纳入文献的研究对象、分析模型、选择项设置及研究结果等。结果最终纳入44篇文献，文献发表时间为2000—2020年。研究对象主要为在职卫生工作者、学生；纳入文献中，6篇是标签式，其余为一般式；属性数量为4~8个；水平数量以2~4个居多（88.6%，39/44）。高收入国家的研究中将全科医生团队合作、工作量作为工作属性；中低收入国家的研究中工作属性选择最多的是住房（21次），其次是设施、药物等的配备（19次）、学习/培训机会（16次）。各文献的工作属性均纳入了收入（工资）。形成的工作属性框架包含4个层面：社会层面，包括医院规模、社会支持/尊重、身份确认（编制或成为永久员工）；工作层面，包括工作地点、工作条件、工作量、工作（管理）氛围、团队合作、上级指导（针对基层卫生工作者）；职业发展层面，包括晋升年限、培训（继续教育）机会、学术和研究机会；生活层面，包括收入、住房、交通、子女教育。分析模型运用最多的是Mixed Logit Model（19次），其次是Conditional Logit Model（9次）、Generalized Multinomial Logit Model（3次）。结论该领域研究结果的异质性较大，难以得出统一结论。而且DCE在卫生人力资源领域的应用仍需进一步在全球范围内推广，相关研究十分有限，得到的证据尚需进一步研究的证实。

关键词: 离散选择实验, 卫生人力, 卫生人员, 职业选择, 研究方法

Abstract:

Background

Using discrete choice experiment (DCE) to study the employment preference of health personnel to choose jobs can provide scientific and efficient basis for the formulation of policies related to the attraction and retention of health personnel in rural and remote areas.

Objective

To review, summarize and generalize the researches on the application of DCE to the field of human resources for health, so as to provide reference for future research.

Methods

Web of Science, PubMed, CNKI, Wanfang and VIP were systematically searched for literature related to DCE application to the field of health human resources from February to April in 2022. The data of included studies such as study objectives, data analysis models, the choice item settings and results were extracted.

Results

A total of 44 papers published from 2000 to 2020 were finally included. The study objects were mainly health workers in service and students; six studies were labeled and others were unlabeled in the included papers; the number of working attributes ranged from 4 to 8; the number of levels of working attributes was predominantly 2 to 4 (88.6%, 39/44). The teamwork of general practitioners and workload were used as working attributes in the studies in high-income countries; the most frequently selected working attribute in studies from low-and middle-income countries was housing (21 times), followed by essential equipment such as facilities and medications (19 times), and learning/training opportunities (16 times). Income (salary) was incorporated into the working attributes across the literature. Furthermore, we formulated a framework of working attributes containing four aspects: social aspects, including the hospital volume, social support/respect, identification (establishment or becoming a permanent employee) ; working aspects, including working location, working conditions, workload, working (management) atmosphere, teamwork, mentoring by supervisors (for primary health workers) ; career development aspects, including years of promotion, training (continuing education) opportunities, academic and research opportunities; life aspects, including income, housing, traffic, and children's education. Mixed Logit Model was the frequently used analytical model (19 times), followed by Conditional Logit Model (9 times), Generalized Multinomial Logit Model (3 times) .

Conclusion

The heterogeneity of research findings in this field is large, making it difficult to draw uniform conclusions. Moreover, the application of DCE in the field of human resources for health still needs to be promoted globally. Relevant studies are very limited and the evidence obtained needs to be confirmed by further research.

Key words: Discrete choice experiment, Health workforce, Health personnel, Employment preferences, Research methods

中图分类号:

R 192

包美玲,黄存瑞,王皓翔. 离散选择实验在卫生人力资源领域的应用进展[J]. 中国全科医学, 2024, 27(25): 3184-3191. DOI: 10.12114/j.issn.1007-9572.2022.0664.
BAO Meiling,HUANG Cunrui,WANG Haoxiang. Advances in the Application of Discrete Choice Experiments in the Field of Human Resources for Health[J]. Chinese General Practice, 2024, 27(25): 3184-3191. DOI: 10.12114/j.issn.1007-9572.2022.0664.

图/表 5

图1 离散选择实验的选择项举例

Figure 1 The example of choice set for discrete choice experiments

图2 文献筛选流程

Figure 2 Flow chart of literature screening

表1 纳入文献的发表时间分布情况

Table 1 Distribution of publication time of the included literature

年份（年）	发文量（篇）
2001	1
2008	1
2010	3
2011	2
2012	4
2013	5
2014	4
2015	8
2016	7
2018	2
2019	6
2020	1
合计	44

表2 纳入文献涉及的研究对象分布情况

Table 2 Distribution of research subjects involved in the included literature

研究对象类型	频次（次）
在职卫生工作者
医生	23
护士	10
助产士	5
医技人员	1
药师	1
社区卫生工作者	7
学生
医学生	7
护士生	7
助产专业学生	2
实验室学生	1
药学专业学生	1
实习生	1

图3 卫生人力资源领域应用离散选择实验的工作属性设置框架

Figure 3 The framework of working attributes based on discrete choice experiment in the field of human resources for health

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