Factors affecting job choices among primary health workers in China: a discrete choice experiment study

Abstract

Primary health workers (PHWs) are crucial for primary health care, yet shortages and maldistribution persist in China. The study aimed to quantify their job preferences and the importance of key job attributes to inform attraction and retention policies. A discrete choice experiment (DCE) was conducted among 433 PHWs in Shandong Province. Six job attributes were evaluated: monthly income, career development, facility conditions, welfare benefits, workload, and training opportunities. Twelve choice sets, generated via an orthogonal design, were analyzed using a mixed logit model. Willingness-to-pay estimates, subgroup analyses, and job uptake simulations were performed. All six attributes significantly influenced job choices. Welfare benefits were the most valued non-income attribute, with PHWs willing to pay approximately 1115 RMB per month for comprehensive social insurance and housing funds. PHWs were willing to pay approximately 1047 RMB per month for a normal workload. Sufficient training opportunities were valued at 927 RMB monthly. Career development and facility conditions were relatively less important. Subgroup analyses indicated physicians valued facilities more than nurses, and male PHWs were more tolerant of heavy workloads. Simulations showed improving income, welfare, reducing workload, and providing training would substantially increase job uptake. PHWs’ job preferences are primarily driven by economic incentives, followed by workload and training. Integrated incentive packages combining financial rewards, manageable workloads, and professional development are essential for improving PHW attraction and retention.