Job Preferences For Undergraduate Healthcare Administration Students In North China

BackgroundIn China,healthcare administration is a subject that explores the development rule of health service enterprise,the task of which is to study the theory and methods of health management,health policy fit for the situation of China,organization management or work method in step with the correct policy,and the experience of health management from the countries all over the world.Graduates from the healthcare administration undergraduate program in China are equipped to work as administrative staff in various health institutions,such as hospitals,health inspection institutes,and the center for disease prevention and control.The number of healthcare administrators in China is deficient compared with other countries and above 96%of the final year undergraduates healthcare administration students prefer to find jobs through the talent market and concentrate in large cities;only less than 4%plan to devote themselves to the rural areas.One survey conducted by Fudan University in 2010 indicated nearly one third of their final year undergraduate healthcare administration students were employed by enterprises which are unrelated to any type of health field or science.Although the Chinese government has launched major reforms of the healthcare system to attract health professionals to work in rural areas,the unequal allocation of human resources for health has worsened.Along with the current healthcare reforms in China,effective policies will be needed to develop and manage its health workforce.ObjectiveThis study was a quantitative study aimed at using discrete choice experiment(DCE)to elicit job preferences of final year undergraduate healthcare administration students in China(whose career-related decisions are crucial to the development of the health service in the future),and it represents the first DCE in this context.Results from this study will provide guidance on career choice and planning for students and inform policymakers to develop more effective policies for the attraction and retention of healthcare administration students to health institutions,especially to rural and remote health institutions.Specifically,the objectives of this study include:(1)to describe undergraduate healthcare administration students basic information and their career choice and planning;(2)to establish the job attributes and their corresponding levels;(3)to explore the students job preferences and inform policymakers to develop more effective policies.Data and MethodsThe methodology of DCEs is presented as an example of the stated preference method(SPM)that allows for measurement of health workers' preferences for a combination of job attributes,and quantitatively predicts the job uptake given a set of job characteristics.It has become a commonly used instrument in health economics.Random utility theory provides the theoretical foundation for DCEs:a discrete choice is offered and participants choose the option with the highest utility among the alternatives presented.(1)Sampling:This study used a multistage sampling design.First,seven provinces were selected according to their economic development level to represent eastern(Heilongjiang,Liaoning,Beijing and Shandong),middle(Shanxi)and western(Gansu,Ningxia)China.Next,one or two universities were chosen based on the representativeness of their socio-economic status and the development of the healthcare administration subject.Finally,the participants of this study were recruited from university under the direct affiliation of the central ministries and commissions(Lanzhou University),universities of traditional Chinese medicine(Beijing University of Chinese Medicine,Shandong University of Traditional Chinese Medicine)and provincial independent medical universities(Harbin Medical University,Dalian Medical University,Weifang Medical University,Shanxi Medical University and Ningxia Medical University).We aimed to recruit a minimum of 100 respondents in eastern,middle and western China.Consequently,one to three classes in each university were randomly selected depending on the number of students in each class.And the total number of the samples was not less than 600.(2)Attributes and Levels:the final six attributes and their levels were determined on the basis of the literature review,in-depth interview,focus group discussion as well as discussion with a senior health economist who is an expert on DCEs.The six attributes including:location,monthly income,bianzhi(which refers to the established posts and can be loosely regarded as state administrative staffing),training and career development opportunity,working environment and workload.(3)Questionnaire Design:A D-efficient(Dzerror;i.e.zero priors assumed for all variables)design,for main effects only,was developed using Ngene 1.1.2(Choice-Metrics,Sydney,Australia),which yielded 24 choice sets that were further divided into two blocks so as to minimise participants',cognitive burden.Within each version,a single choice set was duplicated to examine the internal consistency of participants.A pair wise binary two-stage response DCE design was used to maximise the information gained from the participants.In the first stage,each participant made a choice between two alternative job scenarios.Secondly,participants were asked a follow-up question as to whether in real life they would be willing to participate in their preferred job from stage one.The above two questions were combined together for analysis to take into account an 'opt out' option.(4)Pilot Testing and Data Collection:The full questionnaire was piloted among forty final year healthcare administration students in Weifang Medical University before data was collected between April and July,2017,aiming to examine the comprehensibility,acceptability,and validity of the questionnaire.(5)Data Analysis:Data were double-entered into EpiData 3.1(EpiData Association,Odense,Denmark)and transferred to Stata 12.1(StataCorp LP,College Station,Texas,USA)for processing and analysis.Descriptive statistics were reported for participants'socio-demographic characteristics.Two econometric approaches were used to estimate this utility function,including the classical conditional logit model and a mixed logit model that could be used to capture potential unobservable preference heterogeneity.Conditional and mixed logit regression models were compared using the Akaike Information Criterion(AIC)and Bayesian Information Criterion(BIC),which is commonly used for model selection in random utility framework.ResultsThe response rate to the questionnaire was 95.2%(668)out of 702 for final year healthcare administration students.Of these,22(3.3%)participants who did not complete the majority of DCE tasks were excluded from the analysis.For internal consistency,a choice test based on duplicated choice tasks among the remaining 646 participants resulted in 69(10.7%)participants failing the test,and there were no statistically significant differences on demographic characteristics between those who failed versus who passed the test.For those participants who passed the consistency test,they(n = 577)had a mean age of 22.2 years(standard deviation,SD = 1.07),most(74.5%)were female and only 31.9%participants came from urban areas.For the DCE results,the statistical significance of at least one level of each attribute indicates that all key characteristics identified in the DCE design stage played a significant role in job choice and on average participants in this study indicated a negative preference to take a job(as indicated by the significantly positive coefficient attached the alternative-specific constant,'ASC(opt-out)').For the non-monetary factors,light workload was most strongly associated with job preference,followed by working in the city.An unexpected finding from our study is the relatively lower utility of bianzhi in job preferences.The results of the WTP calculation are used for relative comparisons.Compared to the reference levels for each attribute,workload and working environment were most strongly associated with job preferences.For example,students were willing to pay 2439 CNY and 2398 CNY to obtain a job position with light workload and superior working environment rather than heavy workload and poor working environment respectively.For the subgroups,all six attributes remained statistically significant in influencing preferences.Focusing on the WTP estimates,it can be seen that students from single-child family and students who have an urban background and/or with higher annual family incomes were willing to pay more for working in the city.Students from western and middle universities would be willing to pay 749 CNY and 903 CNY more for a job with bianzhi than students from eastern universities respectively.The simulated preferences for job posting under various potential policy scenarios shows the varying probabilities of taking a rural remote job versus one in the city,with various job conditions.For the single incentives,if superior working environment was provided for the rural remote job,the probability of taking that job will increases to 0.534(so the remote job is preferred).For the selective multiple incentives,the policy "sufficient training and career development opportunity + light workload + 5000 CNY" was the most attractive one,as it can increase the probability of taking rural job to 0.919.Conclusion and Policy ImplicationsTo the best of our knowledge,this is the first study using DCE methodology to investigate job preferences of healthcare administration students internationally.All six attributes considered in our study were found to be statistically significant in influencing student preferences to choose a job.The following policy implication can be drawn and proposed based on the findings of this study:(1)Not only monetary but also non-monetary attributes have a large influence on healthcare administration students' job preference.(2)Although higher salary has a large effect on preference for rural positions,it is often not possible in the real world.(3)The effect of superior working environment on job preferences is almost equal to a light workload.(4)Working location is an important driver of job choice.(5)The impact of opportunities for training and career development has been shown continually throughout previous studies,and it was remarkably homogeneous in terms of how this attribute was valued in a health-related job choice by different participants.(6)The bianzhi in the health sector may not be as important as it used to be.(7)Students with different demographic characteristics have different job preferences.Based on the above discussions,the following policy implications can be drawn and proposed:(1)It may thus be wise,after raising monthly income to a certain level,to focus on other types of policies.(2)The government should try their best to improve the quality of the foundational health facilities,and provide superior working environment for the healthcare administration workers.(3)Relevant policies should be made to attract health professionals to work in rural areas and then diminish the reasons for non-retention in rural and remote areas,such as high workload.(4)The government and policy-makers should pay more attention to workload and working environment rather than bianzhi.(5)Attracting and retaining healthcare administration students with a rural background for rural areas would be a more efficient strategy.In addition,it should be considered by policy-makers that offering bianzhi to students from western and middle universities would be more efficient for the recruitment and retention of them to rural and remote health institutions.Innovations and LimitationsThe innovations of this study:(1)This study use discrete choice experiments_a quantitative method for valuing different factors that influence student's job choices.This method goes beyond the traditional qualitative assessments and provides quantifiable data that can better guide the selection of the most appropriate strategies for recruitment and retention in underserved areas.To the best of our knowledge,this is the first study using DCE methodology to investigate job preferences of healthcare administration students internationally.(2)Several quality control procedures had been adopted in the design,data collection,model selection and data analysis,including"internal consistency test","opt out" option and "AIC","BIC".Similar study designs are scarce.The limitations of this research:(1)Due to the limitation of the discrete choice experiment method,we include only 6 job attributes when analyzing healthcare administration students' job preferences,as a result,we are unable to know the effects of other job attributes on job preferences.(2)Only eight universities from north of China were included in this study,further research will be needed to clarify whether there exists difference in job preferences between the north and south healthcare administration students of China.