Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment

Figures & data

Table 1 Attributes and Levels of DCE

Attributes	Levels	Description
Location (The placement locations for doctors and dentists)	(1) Rural or urban*	Areas with good basic living facilities and adequate healthcare services. Transportation accessibility is relatively easy and does not hinder mobility.
	(2) Remote	Areas with challenging geographical conditions, such as mountainous regions or remote hinterlands. Transportation takes more than 6 hours round trip from the district capital. These areas often struggle to meet basic needs and face security challenges.
	(3) Very remote	Areas that are extremely difficult to access geographically, like remote islands or border areas. Transportation takes more than 8 hours round trip. These areas often face difficulties in meeting basic needs and have challenging security conditions.
Medical facilities (Refer to the resources and supplies necessary for the delivery of healthcare services including promotion, prevention, treatment, and rehabilitation. Such as drugs and medical devices)	(1) Inadequate*	Medical facilities are insufficient to support the provision of healthcare services.
	(2) Adequate to standard	There are healthcare facilities and pharmaceutical products available, along with standard medical devices, sufficient to support the provision of healthcare services.
	(3) More than standard	There are healthcare facilities along with pharmaceutical products and advanced medical devices that are adequate and superior, supporting the provision of healthcare services.
Housing facilities (Places where people live or stay, providing them with housing and basic amenities for daily living)	(1) Not available*	No housing facilities provided.
	(2) Official residence	Provided with housing facilities in the form of an official residence during service/employment.
	(3) Housing allowance	Provided with housing facilities in the form of a housing allowance, which will be given in the form of money and paid monthly.
Specialist study opportunities (Chances for individuals to pursue advanced education and training in specialized fields)	(1) Less priority for those who pay for independent studies*	Specialist study opportunities are less prioritized for individuals financing their studies through personal or self-funded means.
	(2) Priority for those who study independently	Specialist study opportunities are prioritized for individuals financing their studies through personal or self-funded means.
	(3) Priority for government scholarships recipients with 2–3 years of assignment	Specialist study opportunities are prioritized for recipients of government scholarships with service tenure, with placements in regular areas for 3 years or 2 years in remote, very remote, or conflict-prone areas.
Security (Measures taken to protect individuals from threats or harm)	(1) No security guarantee from the government*	There is currently no government assurance of security and safety for doctor and dentist, especially in remote and very remote areas.
	(2) Security guarantees are available from the local government	Local government provides security and safety assurance for doctor and dentist, especially in remote and very remote areas.
Length of commitment (The period of time that an individual commits to staying in a specific place before considering relocation)	(1) Willing to work in the same place for 2 years*	Committed to working in the same location for 2 years and not allowed to move elsewhere.
	(2) Willing to work in the same place for 4 years	Committed to working in the same location for 4 years and not allowed to move elsewhere.
	(3) Willing to work in the same place until retirement	Committed to working in the same location until retirement and not allowed to move elsewhere.
Incentive (Rewards offered to individuals as encouragement to take certain actions or achieve specific goals)	(1) Medical services*	Provision of monetary incentives for medical services provided as compensation for individual medical services rendered, typically included in hospital tariff components.
	(2) Regional/central incentives	Provision of monetary incentives based on the region of assignment, educational level, and employment status.
	(3) All incentives (medical and regional/central incentives)	Provision of incentives in the form of service/medical services incentives and regional/central incentives in monetary form based on the region and services provided.
Net income (Income, including basic salary and allowances in a month)	(1) IDR 15 million^a	Totalling income of IDR 15 million monthly.
	(2) IDR 20 million^a	Totalling income of IDR 20 million monthly.
	(3) IDR 30 million^a	Totalling income of IDR 30 million monthly.

Notes: Description: *Level of comparison or control. ^a1 United States Dollar (USD) = 15,129 Indonesian Rupiah (IDR) as 18 January 2023.

Figure 1 The DCE Questionnaire. ((A) Respondent Characteristics Question; (B) Cheap Talk Script; and (C) Round 1 from 18-Choice set DCE Recruitment Section).

Table 2 Respondents Profile (N=158)

Characteristics		n	%
Gender	Female	109	69
	Male	49	31
Age	20–29 years	115	72.8
	30–39 years	37	23.4
	≥40 years	6	3.8
Profession	Dentist	45	28.5
	Doctor	113	71.5
Education graduate	Public university	63	39.9
	Private university	95	60.1
Marital status	Divorced/widowed	1	0.6
	Single	120	75.9
	Married	37	23.4
Number of children	Have no children yet	133	84.2
	Have 1 child	10	6.3
	Have 2 or more children	15	9.5
Born in a rural or remote area	Not	110	69.6
	Yes	48	30.4
Job status	Non civil servants	141	89.2
	Civil servant	17	10.8
Work experience	1–2 years	97	61.4
	2–3 years	22	13.9
	3–4 years	20	12.7
	Over 5 years	19	12
Have worked in rural or remote areas	Not	67	42.4
	Yes	91	57.6
Placement status	Nusantara Sehat Program	91	57.6
	Organic doctors and dentists	20	12.7
	Indonesian doctor internship program	47	29.7
Placement location	Inside the province as region of origin	57	36.1
	Outside the province as region of origin	101	63.9
Placement Region	Western	66	41.8
	Central	47	29.7
	Eastern	45	28.5

Table 3 Conditional Logit Estimation of Retention Doctors and Dentists

Attribute	Levels	Dentist (N=45)			Doctor (N=113)
		coef	OR	mWTA (IDR)^a	coef	OR	mWTA (IDR)^a
Location	Remote (Rural or urban)	−0.0601 (0.2044)	0.9416	427,131	−0.2322 (0.1281)	0.7928	1,725,111
	Very remote (Rural or urban)	−1.7080*** (0.3412)	0.1812	12,130,682	−1.5580*** (0.2148)	0.2106	11,575,037
Medical facilities	Adequate to standard (Inadequate)	1.3190*** (0.2758)	3.7410	−9,367,898	1.0810*** (0.1838)	2.9490	−8,031,204
	More than standard (Inadequate)	1.4880*** (0.2012)	4.4290	−10,568,182	1.1890*** (0.1140)	3.2830	−8,833,581
Housing facilities	Official residence (Not available)	1.2870*** (0.2061)	3.6230	−9,140,625	1.3070*** (0.1323)	3.6940	−9,710,253
	Housing allowance (Not available)	0.4075 (0.2301)	1.5030	−2,894,176	0.6700*** (0.1478)	1.9540	−4,977,712
Specialist study opportunities	Priority for government scholarships recipients with years tenure (Less priority for those who pay for independent studies)	1.2710*** (0.1866)	3.5630	−9,026,989	1.7330*** (0.1309)	5.6580	−12,875,186
	Priority for those who study independently (Less priority for those who pay for independent studies)	−0.2887 (0.2847)	0.7492	2,050,426	0.3759* (0.1794)	1.4560	−2,792,719
Security	Security guarantee are available from the local government (No security guarantee from the government)	1.5840*** (0.2417)	4.8740	−11,250,000	1.4290*** (0.1452)	4.1730	−10,616,642
Commitment Length	Willing to work in the same place for 4 years (Willing to work in the same place for 2 years)	−0.6278 (0.3230)	0.5338	4,458,807	−0.4981* (0.2109)	0.6077	3,700,594
	Willing to work in the same place until retirement (Willing to work in the same place for 2 years)	−0.9983*** (0.2724)	0.3685	7,090,199	−1.6520*** (0.1878)	0.1916	12,273,403
Incentive	Regional/central incentives (Services/medical services)	1.0170** (0.3221)	2.7660	−7,223,011	0.5475** (0.2051)	1.7290	−4,067,608
	All incentives (Services/medical services)	0.5712* (0.2595)	1.7700	−4,056,818	0.1950 (0.1696)	1.2150	−1,448,737
Net income		0.0000*** (0.0000)	1.0000		0.0000*** (0.0000)	1.0000

Notes: *p<0.05. **p<0.01. ***p<0.001. ^a1 USD = 15,129 IDR as 18 January 2023.

Abbreviations: Coef, Coefficient; IDR, Indonesian Rupiah; mWTA, Marginal Willingness to Accept; OR, Odds Ratio; SE, Standard Error.