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Net costs of health worker rural incentive packages: An example from the lao people's democratic republic

机译：卫生工作者农村激励计划的净成本：以老挝民主共和国为例

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Background: Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. Methods: We utilize the findings from the discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People's Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. Incorporating evidence on health worker density and health outcomes, we then estimate the expected 5-year net cost (or benefit) of each incentive packages for 3 health worker cadres - physicians, nurses/midwives, and medical assistants. Results: Under base case assumptions, the optimal incentive package for each cadre produced a 5-year net benefit (maximum net benefit for physicians: US$ 44,000; nurses/midwives: US$ 5.6 million; medical assistants: US$ 485,000). Conclusions: After accounting for health effects, the expected net cost of select incentive packages would be substantially less than the original estimate of direct costs. In the case of Lao People's Democratic Republic, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.
机译：背景：许多发展中国家正在研究是否制定激励措施，以增加选择在农村地区工作的卫生工作者的比例;但是，这些软件包的预期净成本（或收益）存在不确定性。方法：我们利用离散选择实验调查的结果，将其应用于老挝人民民主共和国的卫生专业人员培训和成本分析，以模拟出激励措施对新员工选址决策和直接成本的预期影响。结合有关卫生工作者密度和健康结果的证据，我们然后估计3名卫生工作者干部（医生，护士/助产士和医疗助理）每个激励计划的预期5年净成本（或收益）。结果：在基本案例假设下，针对每个干部的最佳激励方案产生了5年的净收益（医生的最高净收益：44,000美元;护士/助产士：560万美元;医疗助手：485,000美元）。结论：在考虑健康影响后，某些激励措施的预期净成本将大大低于直接成本的原始估计。就老挝人民民主共和国而言，不对资本密集型项目进行投资的激励措施通常应产生更大的净收益。其他发展中国家可能会重复采用离散选择实验调查，成本核算调查和成本效益分析方法，以计算卫生工作者激励措施是否是可行的政策选择。

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