abstract: 'This paper analyses the system of financial and non-financial incentives

  underlying job preferences of doctors in Bangladesh who work both in

  government health services and in private practice. The study is based

  on a survey of 100 government-employed doctors with private practice,

  across different levels of care and geographical areas. In-depth

  interviews were carried out in a sub-sample of 28 respondents. The study

  explores the beliefs and attitudes towards the arrangements of joint

  private/public practice, establishes profiles of fee levels and earnings

  and examines the options to change the incentive system in a way that

  ensures an increased involvement of dual job holding practitioners in

  the priority areas of care.

  Consultation fees were Tk120 on average (range Tk20-300) and found to be

  correlated with the qualification of the practice owner and the type of

  service offered. A majority of the respondents reported at least to

  double their government income by engaging in private practice.

  Significant predictors of total income included the number of patients

  seen in private practice (p = 0.000), employment in a secondary or

  tertiary care facility (p = 0.001) and ownership of premises for private

  practice (p = 0.033). Age was found to be marginally significant (p =

  0.084). No association was found between total income and

  specialisation, private practice costs, level of government salary or a

  degree from abroad.

  The data suggest that doctors have adopted individual strategies to

  accommodate the advantages of both government employment and private

  practice in their career development, thus maximising benefit from the

  incentives provided to them e.g. status of a government job, and

  minimising opportunity costs of economic losses e.g. lower salaries.

  Commitment to government services was found to be greater among doctors

  in primary health care who reported they would give up private practice

  if paid a higher salary. Among doctors in secondary and tertiary care,

  the propensity to give up private practice was found to be low.

  Financial incentives that aim to increase numbers of doctors in rural

  areas, such as a non-private-practice allowance, are more likely to be

  appreciated by doctors who are at the beginning of their career.

  Improved training and career opportunities also appear to be of high

  importance for job satisfaction. Policy changes to ensure a better

  resource allocation to the priority areas of the health sector have to

  reflect an understanding of the incentives generated by the

  organisational and financial context within which dual job holding

  practitioners operate. (C) 2002 Elsevier Science Ltd. All rights

  reserved.'
affiliation: 'Gruen, R (Corresponding Author), London Sch Hyg \& Trop Med, Hlth Serv
  Res Unit, Dept Publ Hlth \& Policy, Keppel St, London WC1E 7HT, England.

  London Sch Hyg \& Trop Med, Hlth Serv Res Unit, Dept Publ Hlth \& Policy, London
  WC1E 7HT, England.

  Minist Hlth \& Family Welf, Policy Res Unit, Dhaka, Bangladesh.

  Minist Hlth \& Family Welf, Hlth Econ Unit, Dhaka, Bangladesh.

  Data Int, Dhaka, Bangladesh.'
author: Gruen, R and Anwar, R and Begum, T and Killingsworth, JR and Normand, C
author_list:
- family: Gruen
  given: R
- family: Anwar
  given: R
- family: Begum
  given: T
- family: Killingsworth
  given: JR
- family: Normand
  given: C
da: '2023-09-28'
doi: 10.1016/S0277-9536(01)00026-0
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: Bangladesh; health economics; human resource development; incentives
keywords-plus: HEALTH
language: English
month: JAN
number: '2'
number-of-cited-references: '23'
orcid-numbers: Normand, Charles/0000-0002-0885-5754
pages: 267-279
papis_id: 0d8880430ed56edec29d6bf72646db3c
ref: Gruen2002dualjob
times-cited: '70'
title: 'Dual job holding practitioners in Bangladesh: an exploration'
type: Article
unique-id: WOS:000173290000009
usage-count-last-180-days: '0'
usage-count-since-2013: '13'
volume: '54'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2002'