Address correspondence to Oliver H. Günther, Ph.D., Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, D-04103 Leipzig, Germany; e-mail: firstname.lastname@example.org. Beate Kürstein, M.D., is with Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany. Steffi G. Riedel-Heller, M.D. M.P.H., is with Public Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany. Hans-Helmut König, M.D. M.P.H., is with Health Economics Research Unit, Department of Psychiatry, University of Leipzig.
The Role of Monetary and Nonmonetary Incentives on the Choice of Practice Establishment: A Stated Preference Study of Young Physicians in Germany
Article first published online: 24 SEP 2009
© Health Research and Educational Trust
Health Services Research
Volume 45, Issue 1, pages 212–229, February 2010
How to Cite
Günther, O. H., Kürstein, B., Riedel-Heller, S. G. and König, H.-H. (2010), The Role of Monetary and Nonmonetary Incentives on the Choice of Practice Establishment: A Stated Preference Study of Young Physicians in Germany. Health Services Research, 45: 212–229. doi: 10.1111/j.1475-6773.2009.01045.x
- Issue published online: 8 JAN 2010
- Article first published online: 24 SEP 2009
- Physician shortage;
- stated preferences;
- discrete choice experiment
Introduction. The study aimed to quantify the preferences of young physicians for different attributes relevant to practice establishment in Germany.
Methods. Qualitative in-depth interviews of 22 physicians were conducted to identify relevant practice attributes. Based on this information, a questionnaire was developed containing a discrete choice experiment comprised of a “best–worst scaling” (BWS) task. It was mailed to a representative sample of 14,939 young physicians who were close to making a decision regarding practice establishment. Regression analysis was used to estimate utility weights quantifying physicians' preferences for practice attributes.
Results. Qualitative interviews identified six attributes: “professional cooperation,”“income,”“career opportunities of the partner,”“availability of child care,”“leisure activities,” and “on-call duties.” For the BWS task, 5,026 returned questionnaires were analyzed. Results indicated that a change in income led to the largest utility change compared with changes in other attributes. Additional net income to compensate the disutility of a rural practice as compared with an urban practice was 9,044€/months (U.S.$ 11,938). Yet, nonmonetary attributes such as on-site availability of childcare and fewer on-call duties would decrease the additional income required to compensate the disutility of a rural practice.
Discussion. The results offer quantifiable information about young physicians' preferences in establishing a practice. It can assist health policy makers in developing tailored incentive-based interventions addressing urban–rural inequalities in physician coverage.