2023-09-28 14:46:10 +00:00
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abstract: 'This paper analyses the system of financial and non-financial incentives
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underlying job preferences of doctors in Bangladesh who work both in
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government health services and in private practice. The study is based
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on a survey of 100 government-employed doctors with private practice,
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across different levels of care and geographical areas. In-depth
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interviews were carried out in a sub-sample of 28 respondents. The study
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explores the beliefs and attitudes towards the arrangements of joint
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private/public practice, establishes profiles of fee levels and earnings
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and examines the options to change the incentive system in a way that
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ensures an increased involvement of dual job holding practitioners in
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the priority areas of care.
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Consultation fees were Tk120 on average (range Tk20-300) and found to be
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correlated with the qualification of the practice owner and the type of
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service offered. A majority of the respondents reported at least to
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double their government income by engaging in private practice.
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Significant predictors of total income included the number of patients
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seen in private practice (p = 0.000), employment in a secondary or
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tertiary care facility (p = 0.001) and ownership of premises for private
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practice (p = 0.033). Age was found to be marginally significant (p =
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0.084). No association was found between total income and
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specialisation, private practice costs, level of government salary or a
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degree from abroad.
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The data suggest that doctors have adopted individual strategies to
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accommodate the advantages of both government employment and private
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practice in their career development, thus maximising benefit from the
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incentives provided to them e.g. status of a government job, and
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minimising opportunity costs of economic losses e.g. lower salaries.
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Commitment to government services was found to be greater among doctors
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in primary health care who reported they would give up private practice
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if paid a higher salary. Among doctors in secondary and tertiary care,
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the propensity to give up private practice was found to be low.
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Financial incentives that aim to increase numbers of doctors in rural
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areas, such as a non-private-practice allowance, are more likely to be
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appreciated by doctors who are at the beginning of their career.
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Improved training and career opportunities also appear to be of high
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importance for job satisfaction. Policy changes to ensure a better
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resource allocation to the priority areas of the health sector have to
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reflect an understanding of the incentives generated by the
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organisational and financial context within which dual job holding
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practitioners operate. (C) 2002 Elsevier Science Ltd. All rights
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reserved.'
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affiliation: 'Gruen, R (Corresponding Author), London Sch Hyg \& Trop Med, Hlth Serv
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Res Unit, Dept Publ Hlth \& Policy, Keppel St, London WC1E 7HT, England.
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London Sch Hyg \& Trop Med, Hlth Serv Res Unit, Dept Publ Hlth \& Policy, London
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WC1E 7HT, England.
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Minist Hlth \& Family Welf, Policy Res Unit, Dhaka, Bangladesh.
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Minist Hlth \& Family Welf, Hlth Econ Unit, Dhaka, Bangladesh.
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Data Int, Dhaka, Bangladesh.'
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author: Gruen, R and Anwar, R and Begum, T and Killingsworth, JR and Normand, C
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author_list:
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- family: Gruen
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given: R
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- family: Anwar
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given: R
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- family: Begum
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given: T
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- family: Killingsworth
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given: JR
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- family: Normand
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given: C
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da: '2023-09-28'
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doi: 10.1016/S0277-9536(01)00026-0
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files: []
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issn: 0277-9536
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journal: SOCIAL SCIENCE \& MEDICINE
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keywords: Bangladesh; health economics; human resource development; incentives
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keywords-plus: HEALTH
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language: English
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month: JAN
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number: '2'
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number-of-cited-references: '23'
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orcid-numbers: Normand, Charles/0000-0002-0885-5754
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pages: 267-279
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papis_id: 0d8880430ed56edec29d6bf72646db3c
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ref: Gruen2002dualjob
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times-cited: '70'
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title: 'Dual job holding practitioners in Bangladesh: an exploration'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000173290000009
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usage-count-last-180-days: '0'
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usage-count-since-2013: '13'
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volume: '54'
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web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,
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Biomedical'
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year: '2002'
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