. ... ... .. . . . .. .. . ... ..... ... ... . . .. ... .. .. . ..... .. ... .... .... ....... . .... ... ... . .. .... . .. .. ... . ...... .. .. .. .... ...... . ..... .. .. . .....Journal of Health Systems Research . ... ... ..... .. .. -..- -. -..- -.-.... ..., ......... Honorary Advisors... ..v.... ......, |.....,....... s..,... v.......:.,.. . s.,.....,.. -,.....,,.. .,..Editor.... s..,..,,.. ..., . :... -...... |,... :... ......,Associate Editors... .......,... |... s,.. -.. ......Members.... ....,..,.. ..., . :... -...... |,... :... ......,s.... s.......,.. |... .... s,.. -.. c....... ...... ..., . .... |... ... ......,s.. s...... ..., . :... ..... ......,.... ...... ..., . :... .....,... ......,s.. ....,.... -.. ...... .. |... s.. ...., :. ......,...... v....v.. ..., . .... |... ..... ......,.... ..... |... ......... . ....,, ... ..,....,.., ..,...,... s.. :... ... .. |,...Journal Manager..,. .... |... s,.. -.. ......Editorial BoardJournal of Health Systems Research The Journal of Health Systems Research is a publication of the Health Systems ResearchInstitute, Thailand for the presentation of current academic knowledge and research works, par-ticularly on public health systems. It is published quarterly in March, June, September andDecemberOffice Health Systems Research Institute.. ... ..... |... s...., .... |... -:....., . .... |... :., ...... ....... ::.. . s. .. . s. .:..... ..., .........Editorial Board .-. Contents aaaaa caa aaecaaasaaaaaasnv .v.nnn. rnn. .vnnn~.v nnn~nn. nnrnaaaz saaa a aaa aaz aanv .v.nnn nv .nvn. .nvn.n nvnnn~n. .n.n nnnn n.n+aa ac aa aaaac acsaaec aaaaa+asnnc r~c.aa+aaaaaaa+asazen nnv.. ..v. nnnv~n ... nnc .~.m EDITORS NOTESPECIAL ARTICLESz caa ;o-c | +c :|-|, ||c|v..tut u.,.v~...tvu~:... uc~.\..v.~ ;c.~cc.~.~u, vcut.tc/.v..: u~: r- .o|-+- :,|-:|: | :;| c-|-cc| -|oc. | -|| :-c.|:-: | |- ;;-c c| |r||+v..tut u.,.v~...t..~cc :.,cc\...~ c/:.~...:+u::..: ;.~:/...tut ./.t.t:~t.~ u:/...: ..~~..t~v..cc ..~...:/.tutREVIEW ARTICLESz ccc-| ::-;|: -+|:| -ccc +|::|:c-u~.t n.~:ca.:/ORIGINAL ARTICLESsa a||||+- + cc| , | :|:-: | -o|,c+|-+ +:|c:\~t.t v...,.., ..~./.c~.:/.c~.,, :.cu.../.: c/.~:.~..~,. ..:.~.:.a. ~v.~,uJournal of Health Systems ResearchVol. 6 No. 1 Jan. - Mar. 2012 .-. Contentsaa aa a+as aze ca a as a. a a aaeaaaaaaaaaaan nnv.. ..vn . n~n ..ca aaaaca ea s sazea s aac aaaa+as aase. .n~~nnnn .... ~nr.v n. aa cs aa aa aa a aaaa aa aaaaaaaaaaan nnv~n ... nn .~.m.n r~.~ .aas z ac aa azaaaa aa s ceaac .nv. u~..v nnc.nnc v.~nn n. c aaaa saa aesz+a aaaa za a+a. aaasaaaaa a c.o .ev.nv .~.~n n..v+a ao | ||c:| -o +:|c: | oc. | cc| c-:.a:| a|::c-|- c|:- t.;-c|-| (act,\~t.t v...,.., ..~./.c~.:/.c~..~~.t~ \cc.~,. ..:.~..../.: c/.~:.~.+s t||-:|: | |:c-:| c+:|; ||o:- +-||:|: ;-c|c:- | :||, :;|||:u~cc ~t~t.:/c:c: ../.vu:;.uv.: uu..t.u/.u.,. v.t./.c~sa t;|,-| --||| ;:.-: | ||c:| -||oc.|c:- | ;||: -|| |:|||||-:\~t.t v...,..../.: c/.~:.~..~,. ..:.~.:..a. ~v.~,uc/..~ :.t..~t/.~. ..::z s-:||| | |+ c+ | | ;c|c, s :|+-|:\~~u./ ;.../uc~v.,. v/~ut..~,. v/uttcau..t c/..,.~./.t./~ ./...~.ss r|.- -c: | rc:|-cc| a-|| c-|-c: |r a+||:|c||.- ac|:||: + n|:|;||||-:. a-|| a-:-|c||:||. zaa:za+....~ u..~:~v... :.cv.../.c~Journal of Health Systems ResearchVol. 6 No. 1 Jan. - Mar. 2012 .-. Contentsac s scae aaaa aaaaec c as aa s a aaza a sa aa +as+ase aazaaezaaenv~n .~n. n . .r~nnv .n.~c~n .r~n~n. ~.a aaaa s a aaaaaaaaazacas aaae zsss aeaa zss+..n nnnn rn~u~~ ..nvac e+aa seaa a se s aaaaaaa a s.. vvcaaaaa +c c aszac azaa a sa a asaaasaa+ccasazaac ~v.nvn nvnv n~~..nn nn.naaccaaaenv .nvnaa c;c|: | ec:-||:| cc- a|:-: |cc|: a|:-:- e||-|: c-:-|.| s-|||| ec-::c|;|| -|o-- a::c-+||-+ c||, ec:|-:+ ;c|c, :c- ||:. n sc. ec.|:-v/., t.~ct~u~./.~.~.~ v.::.~../:.~.:uu.t. ./v.~~.v.::.~. c~.~tvcc.,. ..att.: ~/.... :.v.:z c|+ w-|-c a-| sc.-|||:- | r||+.a:|-c zaa r-cc, za.~./ ...~../v.~~.. c.u~/uc~.~~ .~./.~:.s c;||:- | c-:-c: ;c,-:|: | |- t||:||+-||- | c-:-c: ...:cc .c.~./..zs r- c-:|| | |;|--|| -|oc. | :c- |c;:| ;-c||.- .|.|c -c| ;||-|: o :-o|c|ru.acc ..,.v~./...cc.~ :.:/c.~~./.,. ...~t/.vu:u.~ vu.~LETTER TO THE EDITORs+ e|-:- ;+|- |- ||c||v~./.. .:/...~tutJournal of Health Systems ResearchVol. 6 No. 1 Jan. - Mar. 2012o o . oooo . . . . . . . . . . . . ... . . . .. . .. ... . . . .. . . . . . . . . . . . . . . .. .. . . . . . . . . . . .. . . . . . . . . . . . ... . . . . .. .. .. . . . . ... .. .. . . . . . .. . .. . . . ... .. . .. . . . . . . .. . .. . .. ..... aa+ araaaae a.arae asaas asara a a a . . arar ea.a enee r aarr n raa . .. . .. . . . .. . . . . ...... . . . .. . . . . .. . .. . . . . . .. .... . . ....... ..... . .... ... .. . . . . . . . . . .. .. . . ... .. . . .. .. . . . . .. . .. . . ..na aa.anaa CNN * #* #2o o . oooo . eaa aa -s.,.-a a-. a.:=-....,.. . .... . .. . . . ..,.. . .. . . . . .. .. . . . . ... . ...... . . .. . . .... . ..... ...... . . . . . .. . . . ..... . .. ... . .. ..... .. . . . . . . . . . . . .. ..... .. . . . . ... .. ... .. .. .. . n.as/a .r a . . . . . .. ... . r aar n aas +a ra a a a+aaa . ... .. ,,., ... . . .. . . .. . . . . . .. . ,.. ..,.. .., ..,.. .. ..,.. .... . . . . . . . .. . . ..,.. . .... .. ..,.. . . ..... O .... . . . ..Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. ..O . . . .. . . . . .. .. . . . . .. .. . .....O . .. . .. . .. . . ...... ........ .. ..- . . . .. . .... - ..,.. .. .. . . ... ..,.. . . . . . . . . . . . .. . .. .. ..,.. .... .... . . . . . . . .. . . . . .... -. ... . . . . . .. . . . . . .. . ... . . .. . ... ... .. . . . . . .. . . . . . . . . .. . . . . . . . . . . . . .. . . . . .. . .. . . . . . . . . . . . . . . . . . . . ... . ... . . . .. a.aasasa .z aa a aa a + aa a a a .z . .. .. . . ..... . . . ... . .. . .. . .. . . . aa aaa s+ aa a + r .+a a.aa+saaasa. . . ..... .. ...... .. . . . . . . . . . . . . . . . . . .... . . . . . . . . .. . . . . . naa aaaasanaaaa a. a.a +aaaa+aaa a aaaaa aa a a + a.as + . . . . . . . .. .. . ..... . ...........O .. . . . . o o . oooo .4...... . . . . . O . .. . . . . .. .. .O . .. . . . .. . .O . . . .. .. . .. .... . ... .. . .. . . a aa a. .. . . . .. . . . . .. .. . .aa aaa . . . . . . .... . . .. . . . .. ... . ........ . . ... ... . .. . . . raa.a.a ..... . . . . . . ... .. .. .. .. .. . . ..aaaaaaaa.aaaa.aana +r asaa . . ..,.. .. ..... . . . .. . . . . . .. ... .... .. . .. . . .. . ... . . . ...aa a sa . . .. . . . . . . .... . . . . . ...., s ...,.. ...... ... .. . . . . . .. .. . . . . . . . . ..,.. -s.,.-a r a r a an . asaaaaaaa.aaa .. . .. aa.a aauaraaaa ..,.. . .. .... .. ...... .... . . . . O . . . ... . . . . ... ...O .. ... .. .. . . . . . . .. . . .... ..Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 O .... ........O . . . . .. . . . . . . arra . . . . .. . . . . . . .. . ... .-. . ... . .. . . . . . .. . . .. . . . . ..........,.. . . . . .. . . . . . . . .. .. . . . .. . . . .. . . . . .. . .. . . . ... ...... . .. .... .. . . .. . . . .. .. . .. . ... .. . . . . . .. . ..... .. ... . . . . . . . o o . oooo .6. . .. . . . . . . ..... ... .. ..,. ... ... .. . . .. . .. . ... .sa.ara . . . . .. ... ... . . . . . .. . .. . .. .. .. . .. . . .. .. .. .. .. .. .. . . . ... . .. . ..... . .. . .. ... . ... .. . .. . .. . . . .. . .. .., .... . . . . .. . . s,.. ..... .., ,...,. ... ... ,,.. ,.. ,..., ... .... ..,. . . . . .. . . . . . . . .. . . . . . .. . iBalas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany:Schattauer Verlagsgesellschaft mbH; 2000 * # *nvn..v:n :r.vv:rn.vn.n .v.r:.v.v .v.r:.v:rnv.r:#.::..::....r .. `+a.a + ..++. +. ....a. .v.. ..u . ++v . ++.+.u.+.+. +. +.a .. .u. .+ .v . . .. .u...+v+...a..++. . .+ .u+..++.+.u. + .-- .u. .. . +u+-. +..v ..u .a.aa .a. . u +++. +. . u. .. .va . . + .+. + + . . +. .v .. a.a...va .. + .ua+...u. .. .. +. a . .v +.u .|..aa .u v + aa +. a. . a. +. a . - .u a..a.u .|arua. +.v. . ..a+aa a+u . .. + v..au+ a . +a++. ..a+. ..v. ..a. a..+.+. au .. a...au . . a . .v. .u+-.-. .va.. v .v . . ++. . . .... .+ a.+.+a . . +aa. a +ar u .a a.+a. +.a..a aa a+.a+a+.ua.a a+ v + . + +.+ .. a..u.a. a+ aa.a.: , , Abstract The knowledge synthesis in shaping referral network of health services in the upper north ofThailandPaibul Suriyawongpaisal*, Toranee Kayee, Narain Chotirosniramit, Yuttasart Janthip, SrisakulThipkamol, Krongkarn Sutham, Visit Tangnapakorn#, Rassamee Tansirisithikul**Faculty of Medicine Ramathibodi Hospital, Mahidol University, Nakornping Hospital, Maharaj Nakorn ChiangMai Hospital, Sansai Hospital, #Bureau of Inspector - General, Ministry of Public HealthThere is a notion saying the most reliable prediction of the future is to build it. This synthesis oftacit and explicit knowledge in shaping referral network of health services in the upper north of Thailando o . oooo . o o . oooo .8 .. . .. . . . ... .. .. .. . . . .. . .. .... .. .. .. . - . .. . . ... . . . . . . . ,. .,... ,.. .. .... - . . .. .. . . . . . ... . .aa aa. aas aa ar.aaar e- . .. .. ... ..... . . .- . . . . . . . .. . . . . . . ... ..-.. . .. . . .... . . . .. ....... .. . . . ..... .. . . . .. . ... . . ...... .. . . . .. . .. .. . . .. . . ..reflects collective actions among doers of the region in accord with such a notion. The actions started froma health manpower crisis of the former single node of referral chain in 2006 characterized by draining ofalmost 300 nurses instantly from the node hospital to private hospitals after dramatic increased workloadwithout perceived competitive adjustment of financial incentives. The crisis forced the node hospital toshift its policy of hospitalizing referred cases from unlimited to a limited quota. Joint coordinating andcollaborating mechanisms among networks of public and private hospitals were set up under the jurisdic-tion of public health administrative region no. 15. The mechanisms facilitated 1) restructuring roles andfunctions of the hospitals into zones of referral chains each with a node and sub-nodes; 2) capacity build-ing of public hospitals under the restructured zones; 3) planning of human resources, service delivery andupgrading of facilities including buildings, medical equipment and communication technology throughpublic and private subsidies; 4) adjustment of payment mechanisms to mobilize previously untappedcapacity i.e., specialized cares of private hospitals; neurosurgery of a public hospital which previouslyexcluded emergency cases. During 2008-2010, evidence has shown a decline in the number of referredcases being turn away; better access to standard care such as thrombolysis for acute STEMI, traumaticbrain surgery; neonatal care. Strengths and weaknesses were discussed. Finally, opportunity for futureimprovement of continuity of care within the referral network was identified in terms of relational, infor-mational and managerial continuity.Key words: referral network, continuity of care, restructure, zoningJournal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. . . .. . .. ... . . . .. .. . . .... . . . . . . ..araar . -.. .. . . . ..... . .. .. . .... .. . . . .. . ... .... . .. . . . . -. -. . . .. . . . . . . . .. . . . . . ... . . . . . .. . .. . . . . .. .. .. . . .. .- .. . . . . . . ... . .... . . . . . . . . .. . . .... . ...++v ... .+v u+-.- , .- .. -. .a..a.u...v+ o o . oooo .10 . . . . . . . . . . . .. .. - . . .. . ... .. .... . . .. .. . . . . ... .. .. .. . . .. .. .. . . .. . .. . . . . . . .. . .. . . . . . .... .. . . . . . . . . ... ... . .. . . .. . . . .. .... . . . . . . . ..... .... ..... .. . . ....... ... . . . . .. ... . ... . ... . . .. . -. . . . . . .. -- .. . . .- .. . . . . . . . . . ........ . .... ... .... .+v.+.u .a u+-.-Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . .. . . . ......,. . ... . . . .. . .. . . . . . . . . .. . .... .... . ... . . . . . .. ......... . . . .. . .. ... ..... ... . .. . . . . . . . . . .. . . . . . . . . . . . . . . . .- . . . . . . . . -. . .... ... ......... .. . . .. . ....... .. . ...... . .. . . ... ..- .. .... .... s.... ...... . . . . .. . . .......... . . . . .. . . .. . .. .. ... ...u+..u.u+.++v .++.av -.- o o . oooo .12 . . . ..... .. . . .. . . ... .. . . .... . .... . ... . . . .. ..... ..........., . ...... ....... ..... . . . .... ... .. . . .. .. ... ... ,..- . . . . . . . . . . .. . .... . .. . ...... . ..........., . . . ....... .. .. . ...... . ... ........ . .. . .. ..anasasaaasaa| . . ... . . . -. . . -- . . ... .. . .. . . .. . . . .. . . . .. . . . . . . . . .. . .. . ... . . .. . .. .. . ........ . .. . .. . .. ... . . .. .. .. . . .. .. .. ... .. .... . . . .... . . . . . -. -. - . ... . .. .. ... .... . . . . . . . --.. . . .. . . . . . . .. .. . . ..... . . . ... .nr..r.. z.:r . ..v.:n.n.vv:n ..n.nr v :::nrv.nr:n::n.vv .nv.:::n.Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012.. . . . . . . . . .. . .... . ... -. . . . . . . .. ... . . . .. . . .. . ... . . ... .... . . ... .. ... . .. . . . .. . . . . .. ... .. .. .. . . . . . . . . . . ... .. . . . . . . . . .... .. .. . .. . . . . ... . . a++ .. v +. ..+.a +.+.+ +.u + ,u + u + +v +.u) CT brain.u+...+c... ...... uu.a.a .+ .+v c v. - .c... ...... .+ a +x..+...a a.a.++v. . +.+ a+u u.+ .....x..+... +|c... ...... uu. .a+. ..a+... ..... auru.: .+v c uu..+.. u .+++. .+..u.u+.x.... +u.a+.u.+ c . .a. cuu..+ o o . oooo .14...... . ...- ... .. . .-. .. . . . . .. .. . . ... . . . . .. . -.-. .. . . -. . ... . . -. . . .. .. . . . . . . . . ... -...... . . . . .. - . .... .. . . ... . .. . -. .- -. .. . . . .. . .. ... . . . -. . . -- . -. . . . . . . . . .. .... ... . . . ..a.aaaseas . . . .. . . .. . . . . ... . . .. . .- -- ..... ,,.... . ... . .. .. - . . . . . ... .. . . .... .. . . . . . . ... . . . . . . . . . ....... . . . . . . . . . . . . . . . . . . ....... .. . . . . . ....... . . ..... .. . . . . . . . .

. . . . . . . .. . . . . . .. ... .- a++ . +.a a +a +a.+.+ a r u +.u...,1. Detection Recognition of Stroke2. Dispatch Call & Priority EMSdispatch3. Delivery Prompt Transport and Pre-hospital notification5. Data ED Evaluation, Prompt Lab. studies, and CT imaging4. Door Immediate ED Triage6. Decision Diagnosis and Decision about Appropriate Therapy7. Drug Administration of Appropriate Drugs or InterventionsStrokeChain ofSurvivalJournal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. . . . .. . . .. . .. .. . - .. .. .... ,.... . . . . . . . ... .. . . . .. . . .. .. .. . .. . .. .. . .. ......... ......, ..,... ......, ...... ......,. . .. . . . . .. ... . .. aeaaaansan.aa. .. . .. . . . .. . . . . .+a+aru +.++ ,.ua..++v++.u+ uu .u.v.+..+..:..r ... nrv:n.::v.:v.:.. :n.:.:.:c... ...... uu.. s... s...r.x rxo ..... +au icui .+. ............ a. i.......... ... ......+.. uu. c... ...... .+u c.... ...+... .++u c.... ...+... ...+.r. rxoa rx+ .+ a.+. .. rx..+.. .ccu .+. u+. . u.a+|c... ...... u..u +... + o o . oooo .16 . .... . . . .. .. . . . .. . .. . . .. . . . . . . . . . . . . . .. . . .. -- . -.. . . . .. . .. . . . . . . .... ... . .. . . .. . . . . .. . .. ..... ,...., ... ... .. . . .. .. . . . . . . . . ... . . . . . . . . .. . .as a ae ar a aaarae.s . . . . . . . . . . . . . . . . . . -. .-. . .... .... . . . . . ...... .. . . . . ... . . . -- -.. .. .. ... . ..... .- .. +.uv.v..+.+v..a.v -. . -.Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . .. . .. . . .. . . ... .. . .. . . . .. . . . ... . ... . ......aaaanrtu --a:.a..:,. ......, ... . . . ...... ......... . ..,... .. . . . . . .. . .. . ... ..r.|.:.-a.| --a:.a..:, .. . . .. .. . .. .. . .. .. . . . . . . .. . . . . .. . . .. . . .. . .. . .. . . . . .. ... ... ....... . .. .... . . . . . .. . ..ta:-..:.-a.| --a:.a..:, . . . . . . . . .. . ... . . . . . . .. . . . . . . . . . . . . . . .. . . . . . ... .. .. . . . . . . . .. . . . . . . . . . ...... .. . . . . . .....u.a.,..a: --a:.a..:, . .. .. . . . . . . .. . ..... . . . . . . . . . . .. .. .. . . .. . . ..... .....,... ..., ,.... ..... .. . . .. . . .. . . . . . .. . . . . .. .. . . .. . . .. . .. . . ... . . ......... ...... ... . . . . . . . .. ... ...... . o o . oooo .18 . . . . . . .. .. . . ... ... . .. . ar.aa a.aas aa.aaaasa.s. . .... . .. . . . . . . ... , ...... . . . .. ... . . . .. . . . . . . .. . .... . . . . . . . . . .. ..... . . .... .... . .. . . . . , . . -. -. . ..... . . . -. -. .- ... ........ .. ... . . . . . . . . . . . . .... :n..rrr.:: r .::nrv.. ,-o.-..o.o-co.-,o,,o.o-.o-,oo..ca.o-o..coo.oo..-oaoacaoo-.-oo-.. -,,.cao,,o-..-o.a.oa.o-,o,ocoa..-a.-. ++a+u.aa..a.+..av -.. +.+.++, * ,.u. u .-.- ..- .--- .-..a .+. - .-- .- --- ,.u. u ...- ..-- ..... .a .+. . -- .- .%case fatality.u. u - -. - -a .+. - - - ,.u. u .- . . .-a .+. .- .- .-. ....... , ..... -. ,a+Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . ... . .. . . .. ... . . .. . .. .. - . . . . ... . . .... .. . . .. . . . .. . .. . .. -. ... -. . . . , . . .. . . .. . . . .. -. . . . . . . .- .. . .. . . .....

...... . ... .... ... .... . . . ..........., . . . . . . .. . . .. . . . . .. . . ... ..... . . . . . .... . . .. . .... . . ...a.aa..+se...... . . .. . . . . .. . ..., . . . . . . . . . . .. . .. . .. . . .-. ... . ..., ... . . . . .. .. . . . . .. .. . . . . . . .. . .. .... . ... . . . . . . .. . . .. . . . . . . . . .. . . . . .... .. . . . .. .. . .. -.. -. . . . . . . .-. . . . .. . . . . .. . .. v .. .r ..~.:n... .r:..r.r.nv :v . r.nn v .~.r.v.v.r..r:n (ra-- :c o a.:-o co o -oa.- .-oa-co ao.-.a.o- .- ca..o-.a o.~ao o .-oo. ,-,.c.a-. a-o -o,.a. caawac- uoa.-a. ... -o (.) ..~..) o o . oooo .20 . . . . . .. .. . . .. . . . . .. . . .. . . . . . . . . . ....... . . . . . . .. . . . . .. . . . . . . ... .... . . . ....ar .. .. . ... .. . . . .. . . . . .. . . . .. . . . . . . .. . . . . .. .. . . . . . . . . .. . .. . . . . . . .. .... ... . . . . ... . . . . ....... + .. . u a .. ......... .. uxt...,//.....,.+..._/.../+..- + .+.a.a,o. .._.... s ,........ ,.+... .....u .+. a ..a . ......... .. uxt ...,//..+._../o.......,....+-. . . . + + v. . + v u+-- . -. uu.. . ++ v a + ..v.uv.. + +.v. uu. . -. s... ..._....,._.. r..,... o.....,..u... x....o.... . ......... .....,... .....,, .. ..... .......... ... ...._....+ ..... .... ........ ..... .. . ,....,....... .,.... . ,.,...... ..+, r......+ .. . ,...,... . +....,... . ..._..., .+.... ...... .. ......+s... s. r... u.... .... r... :: o...... :aa- + u .++. .a.. a,icuu + +.v . u . -. . .u . . +... +.v . +. ..+v .a.+ ..-.- . . + . ++ ...... .cs .... .v. -.. u. ...... r.. ... .. :. .+.. . ..a a .+v +a +a.+.a. .u. .. . . ::+ +.v . .. u +.u.v. .u.- i...... t u.__...,. x.... i x..+. o.._. x r..... .. ..c......., . .... . ....+...,....., ..... ri :aa::::.. . c...._ .. x....... s,.. + +.v. u... . -..- i..... r..,..... ..... r.......... x...... s.,..........x...... ..,......_. i,... . u....... u..... c... c...._. . ,...... +...+ .. ...... .... ...... .. ......+u..... r..., :a...a::s . . . .aaaraa . . . . . ........ *.n..n. nvn. :r.vvv.r: v v . +. av +. +.au . a ... .v +. +. + +. au . a ... +v + a...u a. ..+ aua v +..aava .a....+av..a ...u.a..v+...a.v. .- v+....au+.+..+au..++. r.. iu... r...+.._ . s.... u..... s,.. ..auau...|u+.a.v+a.a.+v..a v .. a.+ aua+ .+a . .. a . a+ .+ a. au a ...au.+.a...+aua+.aa.+...u +...+..v a+++ aua..au+v + a +...v a+a.. . +a ... + .a+.v +.+. a. a +. .+v + a. a..+ ..a. .au+v av av + . +....+ . . + v +v+. a. .v a+.+ aua..au. ...u ++v a a.++.+.a..v....: , Abstract Current concepts on medical error disclosureBoonsak Hanterdsith**Department of Forensic Medicine, Faculty of Medicine, Chiang Mai UniversityRecently, rate of medical malpractice claim and file a law suit on the medical adverse events areincreasing. The primary etiology of claims and filing were adverse medical events which caused by eitherpreventable medical error or mishap. No one wants adverse event occurred. In the past ten years after theInstitute of Medicine (IOM) reported the facts of medical errors in To Err Is Human: Building a SaferHealth System, health care personals have been deeply concerned with and have tried to improve theirpractice for patient safety worldwide. However, there are still many medical errors in recent years andwill inevitably occur in the future. So, health care providers should learn how to manage and disclosewhen the medical errors occur. Several studies have proved that disclosure of medical error have takenmore benefits than risks. The main benefits are decreased in filing rate, decreased in payments for adverseevents, and maintenance of doctor and patient relationships with trust. Disclosure of medical error is theprocess which closely related to the incident report system. The importance of full open disclosure to thepatient after medical error occurrence will significantly increase in the future for patients safety andshould be simultaneously integrated into the mediation system.Key words: Disclosure of medical error, adverse medical evento o . oooo . o o . oooo .22 . ... . .. . .. . . .. . .... . .. -... . . . . . . . . . .. . . . . . . .. . . . . . .. ...... ...... .. .... . .. . . . . ...... . :... .c: ... . ... . |.. s...., s.. |... s,.. .... . .. .. .. . . . . . . . . ... . .. . .. ........ .. ... . .. ... . ....... ... . ...... .. . . . . . . .. .. . .... u..-.| ...-. -.. a-.... .-.a: (a.aeneaana a aaesar.a, u..-.| ...-. . ... .. . . . .. ... . ... .... . . . .. . . .... . ... .. .. ..... . . .. . . .. ..... . ... . . .. . . .. . . . . . . . . . .. . .. . . . . . . . .. ...... .. ......... a-.... .-.a: ... .. . .,... ... .. .... .. ... ... ... . .. . ..., ... ...... .. . .. . . . . . .. ..... ... . . .... ,..... .. . a+a..aa...u . .+.... .....,.... .+.... .... ,.... a ...,Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012.. ... -. ... .. . .,..,. -...... - . ... ..,...... .-. ... .. . .. . . . ... . . . . . . . .. . . .. -. . -.-. . .. . . . -.... . . . .... -. . . . . .... ....... a.,|.,.a-. -. u.|,..-:.-. -.. u..s.,(ae/.r a ae.aa, a.,|.,.a-. -. u.|,..-:.-. . .... ... . .... . . . . . . . . . .. ... . . . . ... .... u..,. ...... u...-: -.... .. .... u.:, -: -... . ...e. u...|.-:.-a . .... u..s., ..... . . . . ..- . .. . . . .. . . ... .. .. . .. . ,. .. ... . . .. . . . . . . . . . . . .-. . ......-... . .. . . . . .... .. .. . . . . ........ ..... ........ . . . . .-- . .. . . . . .. . .. . . .. . . . . . ....-... u..-|-.... -: ..-.| ...-. aaa.a. aa .. . . ... . . . . . . . . :: (co..o-) .:_r:vr.:.:.n.:: (o..o-) .:n:nr.::r .::r:n:n.v (:.:_r:v : .n ) r: .v::::r::r:v.: r . .vr : .v : n .vr .v : :. ::.: .vv . :r : .vv: . nv. : .r::: o o . oooo .24 ..... .,.. . . . ... . ... . . . . . -.. . ~... e...., s.. ~.. s,.. .... . . .. . .. .. . . .. ... . .. ... . . . . . . . . .. .. . .. . ... . -.-. . .. .. .. ... . . .... . . -.. . . . . . . ... . . . . . . . . . ..... .. . . . .. . ... .. . . .. . . . . . . . . . ....... ... . . .... . .. . . . . . . . .. . . .... . . . . . . .. .. . . . .. . ... . . . . . . . .... . . . .. .. . . . .. . . . . .. .. ... . . . . .. . . . . . . . . . .. ... - .. .. .. . .... .. . . .. ..-. . .. .. .. . . . . .. .. ...... .. ... .. .. . ...,. .. .......e. a ar eas a eneaana r.aa. . . . ..., .. ........., . .- . . .. . ... ......-.. ... .. .. . . . . . . . ......-.. .. .. . .. . ..,... . - .. .... .... . . . ... . . ,.... .., . ..... .,...-. . . . . . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . . . .- r .. . . . . . . . .. . . r. . . . . . .. ....... . . . ..... . . . . . .... . . .. . r . .....aaaes+aareasaene. . .. . .. . . . .. . . . . . . . .. . . . . .. ... .. ...-. . . .. . .. . .. . . . . ... . . . ... . .. -. . . . ... . . . . . . . . . . . -. ... . .. . . .... . . .. . . .. ... . . . . . . . ... ... . . . . . . . . . . . .. .. . .. . .. a.r ar eas a eneaanar.aa... aa .aa . . . .. .,..,.. .. .. . .. .. . . . .. ... . . . . . . .. . ... . ... ....... aa.r aa+ ar ea . . ... . -:. .....,... .. .. . .... . ... a a+ aaa . . ... . . . . . .. .. . . . . ..e. a. aaa ... . .. . . . . .. ... . . . ... . o o . oooo .26. . .. .. .. . .. .. . . .. ... eneaa a.r ea . .. . . . . . . . .. ... . . . . . . .. . . .. . . . . .. . .. .. . . . .. ... . . . .. . .. . .. ... . . . . .. .. . .. . . . . . . ... . . . . . . -. . .. . . .. ... . . .. . .. .. . ..,. .. ... . . .. ... . .. . . ... . .. .. .. . ... . .. . . .. . . . . . . . . . .. . . . . .. . .. . . ... . . . .. . . . . . .... .. . .. . . . ... . .. .. . . .. . . . . ....... r eaa . .. . .. . . . . . .. .. .. . . ..... .. . . . .. .. .. . ... reaaa . .. . . . .. . . . .. . . . . . .. . . . ...... ... . . .. . .. .. . . . ... . . . . .. . .. . .. . . ..... . .. . ,.,, . ,.,..,. . . .. . . .... . ... ,.,, . .,.......,. .. . .. . ........ .. . .. . . . . . . . . . ... .. .... .. . .. . . . . . . . ...... . . . .. . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. . . .. ... . ,.....-. a as aa . . . . .. .. aa aaa . ... . . . .... ..-. aaaa ...... . .. . . . . . . .. . . ... ae r++ aa.aaa . . .. .... ... . . ... . .. . . . .. . . - . .. . . . . . ... .. ... . -.. . . . .. . . . . . ... . . . . .. . . .. ... . . -. . . .. . .... . . . . .. . .. . .. . ... .. ... . .. . . . .. ... . . . .. . .... . .. .. ... . . . .. . . ....... ... . ... . . . .. . . . . ...... . .. . . .. . .. .. . ... . . . .... .,.... . . .... . .. . . . ... . . .. . .. . .. .. . .. . . . . . .. . . .. -.. . ... . ... . . . . .. .. . . .. ... .. .. .. . .. . . . . ..... . .- . . .. . ........ . . . . . . .. . . ... . . .. -. . . . .. -. . . . .. ... . . . . o o . oooo .28-.ar.. . .. . . . . . . . .. . . ... . .. . . .. . . .. . . . .. .. .... .. v+..+.au. a.au. v .r ./-. ..- +.a +a .a.++..... ..v+.+.aau. -.--.. +.a +a + v .u.++. .. .. .au vaa.+ . -.--.-.. u .v. .ua . u+ -.... ... + .. ,. .- u+.-. .aa+ .. .v. .ua . ....v. .u vv --,....., . -. ,....+ :a.. i.. ., ......... ..uxt ...,//......,.._../ t..,. tt. r..... o r... ,... ..... r.. i u... v....... . ......+ i.. :aa:-:s-a r...... ix. o... u. x....+.... rx .... ,.. ....,. r... i o...... :aaa ,....., o.. :a.. ,....+ :a.. o..:, ......... .. uxt ...,//,.......,....+./.../+...+/,/.....,+.- o...._... u. v...... .o. r... .o. r.... vi. t..... vr......' ..+ r.,.....' ......+. .._..+.._ ... +...... . .+........ i.. :aa:s-.aa.: r...... .. t..,. tt. t...+ . u..... t. t.... .x. t......o. .. .. i...+.... . .+.... ..... ..+ .._.._.... .. .,.......+ ,...... ..... . ... u.....+ .+.... r....... s..+, io... s.. u..... c... :aa..:.- u...... rc. t.... .v. x..... o r...... .. ......... -.o...... . .+.... .... c.i :aa..a-... r..... t ..,....... ... .. ..+.._,. +....+.._ ... `..+..+._..,... +.._.. .ix :aa..:.:::.- t.... .x. t..... .o. r...... .. t...+ . u..... tr.r..... t. .. .. x...... ...... ..,....... .... ..+ .+.... ..... +.. . .._.._.... x.... . ... u.....+ .+....r....... s..+, iii r._. i .+ .--.::... v u. .. . + . u . +.a . .+ . . u .v. .uv+ ++a..+ . +. . -..---... v u. .. . +u .. . + . u .+. v... . r.. u .v.. ...au u +. a -..---. v u. .. . +u .. . + . u .+. v... . .+.. a... u .v. . a.u --.-. + +.vu . r...v u.u. . ..u +a..u.u -.- -..-.. v.+au. ./-. +. + ...au. .- u+. -. a.au. -....- r._...,..... v o,.... .. +......... . .... .. .+.....s....., .+ i ,r...., s....., u, o.. :aa:,.a:a. . .. i..... o.., v...au.auu . ..u u.u+. -. .-- u .. r + u+ -.- ,....., -.-,....+ --.. i.. ., ......... .. uxt ...,//.....,.._..-. +... u + . . +. +u ,r++a u.u. - ..u u v+ -. ..-- v.+ au a .v+ ./-. +.+.... ,....., ... -. ,....+ :a.ao.. :a, ......... .. uxt ...,//....../........../.o..:a.a:......r....:s:a:s-a-a:,+.-. v+.+ u .... . ...+.. .. . u+ ,....., u+ .-. ,....+ :a.. r.. ., ......... .. uxt ...,//.+......./.+../..+.....,.,.+-:-. t,.. t. o... v.... is. s.....+.. rc. v..._... s. c....r. r,.... . o...... . .,.... .+.... ..... ..+ ......... ... ,......' ....._ . ... ....., . .... ....i..... .+ :aa-.-.sss-Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012- t..._ oxx. r.... o r...... ...., .. ... ..+.._..+.... ......... .+.... ..+...' ,....,... u._ x._ .+ i :a.a ..a.- t... oi. x.... ri. o...... i. x... xi. r.... v. o..._..vc. r...... ox. o...._... u .+.... .... +...... .._,.+......... c..._ ........, ... . ._.. ., . ,......... r.+.... .+... .+ :aas.:-:::- x..+,... tc. i.. rv. x...... or. x.... . u.... st ...,......., +.....+ ..., . ..... ........_ ,.,.....' ....._.. . +.... .+.... .... ioi :aa:.-:s-- r... s. u...... t. x._..s.._.. . s,..... r. x..... c.s.,... o. .. .. . ....,.... +.. .. +...... . .+........ ,....., u+. -. ,....+ :a.. o.. :a, ......... .. uxt ...,//..._./+...+/,../.+...../..:/r...,+.- v...+ u+ -. .. ru+. .. + .- ,. . u+.-. ,....., . -. ,....+ :a.. o.. :, ........... uxt ...,//............._../o../ror/:--/./a-/.:ror.- . . . v...+ r + .+ . u .u .-- ..u .u.ua .a -- .-.. x.... ss. u. o x.. ..._.... ..... ...., ., ..... ... ,..., ... i..... .+ .---..-:.- c..... ux. o... r ...._ ,...... ...., ... ......,.... ..+.... ........, .... r._. i .+ :aa::as.. t..... cr. u,.. cs . .+..... .... +.. . ..._.+...... . .... ..+ .+.... ..... . ,...... u..... ...,...+ :aa::::.. o...._... u. s..++... o. t..... v o....._ u..... .+....r... . r...... r._. i .+ :aa:::.-. s...,... r..., o...... . .+.... .+.... r.... ..+u.......,...+ o.... . c... ,....., o.. :a..,....+ :a..o.. :, ......... .. uxt ...,//,..................../......./+...../...,...,...,,+.. o.+..... o. u..... rc. r_... r. o...._... u .. +...... +....t.._..... .+.... ..... r._. i .+ :a.a-:ss. x.... i. .., xt. .... . o...... . .+.... .... ,..... ..+ ,....... i x s. .+ :aa-sa:-.- t..... . .,._, .. .+.... ,....... .. ..._.._ ........ ....i.. :aa:-.a.. +. .uu ,+... ..ua . .u ,rr .u. r+. . - v ,....., . -. ,....+ --.. o..-., ......... .. uxt ...,//...../..--.-/.,..+/,...r.../......./--.-,+..- +. .uu ,+. .. .v v ..+. . ++a+. iso.. ,.....,. -. ,....+ :a.. o.. :, ......... .. uxt ...,//...../..--.-/.,..+/,...r.../......./::s-,+... o._.. .+.... ..,.., .,...... ..,.+ ......' .+t. x.. :aa-.:a. *, *, *, *,* 30 . .aaau v v . a + +. .a +a .v aru.aaau ..+.+avau+.. a..+.+.+au...+.v -. ..-. aa+. .+.+ a ._......_....+.+ .u au ..+ . ..a v + au .v. - ...+ auu .u + ... + .au v u+ . + r v. -. v . .auu +v......+.+. a.+...... . .au v. . . . + . +. a .+ ... . .uav .+v.+..+.au. aa. v...... +++.u.u. a. a. .a a.au u . +... +. v .. u . +. ..u ....a + .v . ..u.. +.v . +.. a..+......: , , , Abstract Attitude and rural job of choices of newly graduated doctorsNonglak Pagaiya*,, Viroj Tangcharoensathien, Vijj Kasemsup, Apichart Chantanisr*,, SanyaSriratana*,, Krisda Wongwinyou*,*Human Resources for Health Research and Development Office, International Health Policy Program, Faculty ofMedicine Ramathibodi Hospital, Mahidol UniversityDoctor shortage has long hindered the development of Thai health service system. It is thus crucialto understand attitudes towards working and living in rural areas and factors driving job of choices ofdoctors. The cross-sectional study conducted with 1,219 newly gradated doctors in 2011 was conducted.Self-administered questionnaire comprising individual characteristic information, questions on attitudetowards working and living in rural areas, factors affecting their jobs of choice was used. Statistics usedwere percentage, and Logistic regression.The results showed that of the population 1,219 (527 from normal track and 313 from rural doctortrack), the majority of doctors were female. Half of the rural track doctors were from regional areas, andthe majority graduated from regional universities. Whereas, the majority of normal track doctors wereo o . oooo . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012aa .... .. . . ...... . .. .. . . .. . . -...... . . -. . . .. .. . .. . . . .. . ..- . . .. . . .... . . . ....... .. .. ..... . . .. .. -.. --.- -.-.. -. . . . . ... . . . . . . . ... -.. --. . . . . . . . . . ... . . . . .. . . . . . --.... . . .. . .. . .. . :.. .... .. s... ..-.. . ...:.s-. ... . . ... . .. . . . . . . -. .. ........ ... . ... ,.... . -.. ... ...-. .. . . . ... .... . . .. . . . . . ... - . -.. ... .. . c. ..... . ..c.c. . . . . . . . .. .... . . .. . .. . .. ... . . .. . -. . . -.-. . . -. . . .. . . . from Bangkok and vicinity, and graduated from universities located in Bangkok and vicinity. Factors werelikely to affect their job of choices were workplace that : close to their hometown, enhance their learningexperience, provide case consultancy. With regards to their intention to work, few of them intended towork at rural areas after 3 year and factors associated with their intention to work in rural areas were:rural background and regional training.Key words : newly graduated doctors, attitude towards working and living in rural, health workforce plan-ninga o o . oooo .32 . . . . . . . .- -.-. .. -. .... . . ... . .. .. - -.. . . . - .. - -... . . .. . .. . . . . . . . . .. . . . . . . .. . . . . . . . . .. . . . ...a.aaa raa. + a . . .... . . -.... .. . -.raase .aa . . . . . . -. . ... . . . . . .. . . . . . ... . . . . .. . .. . . . . a aa aa. aa s aa . . .. . . . . . . . . .. .. . . . ... . . .......a.a. a s aa . . . . . .. . .,... .,... .. . .aaa..... .. ... . . ... . .- . . . ... .. ... . . .. ... . - ... . .. . . . . . .. . .. . . . . . -. . - . . . . . . .. . . -. . . .. . . . . . . . .. ... . .. . . . . . . .... . . .. .. . . ..Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . ... . . .. . .. . ... . . . .. . . .. .. . . . . .. . . ... .. . . . . . . . . - .. . . . . . . . . . . . . . . . .. . -. . . . - . .... .... . . . . . . . .. . . . - . .. .. . . .. . . ... . . . .. .. . ... .. .. ... .. . . . . . . . . .. . . . .. . -. . . ... . . . . ... .. .-. +.u+.auu+aauv..+.v -.vav. va Jaa. , . ,va ... ,. -.. ,.-. . --- ,. ... ,s sav+s ..uav.+ .. ,. -.- ,....+ - ,-. . ,.-.... ,. -. ,..++.r.+ -- ,- - ,... - ,--. . ,.--..._ . ,-.- ,...s+ . +. .. ,. .- ,.. ..- ,.. ..- ,-aaaaaaJa . +. -- ,-. .- ,-- . ,.. ,..-a aa aava ... ,..u ..- ,.. .-. ,-av .+. ... . ,- .- ,.. o o . oooo .34. . . . . . . . .. . - -.. .. .aaaa . . . ... . .. .. . . . . . . .. . . . . . . . . . .... . . ....., .. . ...-. . ... ......,. - .. .. . . . . .. . . . . ... . . . . . .. . . . .. ... .. .. ... . . . -. . . . . . .. . . . . . .. .. .-- .. . . .. ...... .. .. +u aa.+.+.a+.auu+aauv..+.v -.vav. va Jaa. , . ,sJ .+. . ,- . , ..- ,.. .- ,.-.v ./u... ... ,.- .. ,.u../... .- ,.. -. ,...+. . ,. .- ,-.v.+. - ,-- --. ,... - ,- .. ,-. av.++ u - ,- . ,..+| .- ,.. . ,...._ .- ,.-. --,.--aa a .v.+. ,-. . ,-v.+ . . ,. - ,.-...+./++. ,-. ... ,-v .-. ,.- -. ,.-.v .. ,... - ,.-v +. . ,.. -- ,....._ - ,- .-,.-Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012.araaeaana . . . .... .. . . . . . . . . . . . ... . .. .. .. .... . . . . . .. . .. . . . . . ... . .. . . .. . . . . .. . -. . ..- . ... . . . . . . .. .. . ...... ..... ... .aaaar++aaaasaana. . .. . .. . .. . . .... . . . . - . . .. ....- . . .. .. .. . .. . . .. . . . .. ... . ++..u+.auu+aauv..+.v -.ua.a ,a ua.a ,avav vaJa vav vaJa..va+..|a... --- ,-- .-. ,-. ,--- . ,.--+....+.+..a.... -- ,-- .- ,--- ,.- . ,-..a+.uv.u+.u -- ,--.- --- ,.-- ... ,..- .. ,-...va+...v+..... -- , .. ,.- .- ,.. - ,.-..+.a. .. +.. ... ,.--. -.. ,.-- ,. - ,...v..v.+.. -. ,--- ... ,-.- ,.- . ,-....+.aaa.u+|a+ . ,.. . ,.. .- ,.- .. ,-..vau.u. ..a+ -.- ,.- .- ,-- ,--. .- ,.- . .u.aua..u+.+..a. --. ,. .- , - ,- .- ,--v.u.au +.v..u. . ,-. -. ,... .. ,.. .- ,...u.v+. -.- ,-. .- ,. .- ,.. . ,--..v..u. +..u+. - ,-- .- ,--- - ,-. . ,-a.v+... o o . oooo .36 . . . . . .. ..... . . . ... . . . . ..... . . - . .. . . . . . . . . . . .. . ... ... .. . . .-. . . . . . . . . .. +.+..+.auu+aauv..+.v -. .v...a.a.aua+.auu+aauv..+.v -.a.a. , a.. ,aaavaaavvav vaJa vav vaJa...a.v+.v ... ,.- .. ,. --. ,.-- .- ,.--.... . ,.-. ,. -. ,--. ..- ,-....+.+v a. ..- ,-. ... ,.- ,-. -.. ,.-.......u .-- ,. .. ,.- ... ,.-. -. ,.---...aa+va+.. . ,. .. ,... ... ,.-. -- ,...aa+va.. .. ,..- . ,.. . ,-- .- ,-...aa+va.... ..- ,.- .- ,.-.- . ,-.- . ,....aa+va+.. .. ,.- .-. ,... .. ,-.- .. ,....aa+v v .a. .. ,. .. ,...- . ,.. ..- ,---uiv/.ios...aa+v+a..u. - ,.-. - ,.-- - ,-.. . ,--....++v .-. ,- ... ,.-. .- ,..-. --. ,.-..a.a..au .- ,-.- .. ,. .-. ,.- ... ,..-.a..au .- ,.. .-. ,.-. .-- ,.-- .- ,..a..au .- ,-. .-. ,.-. .- ,... .-. ,.-Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. . .. . . .. .. . . . .. ...- .-.- . . . . . . . . ... . . ... . . . ..... .. a.aa an . a.a ++r ar++aaa.sa . .. . .. . . . .. . .. . .. . .. . .. ... .... . .. .. ..,... -,... . . vv . ..u .u .a . a +.au u +aau v. .+.v -.u+aaaavva u +a a aa a J +v Ja v Ja.u. -- ,- -- ,- . ,..- . ,.-.u+ / v - ,.. . ,.- .. ,.-. ,.-.u. ,. -. ,. .- ,. . ,.-.u + | . ,.- .. ,- . ,-. .- ,..u/ .+. . ,-. - ,-. . ,-. . ,--+ . + .. ,... ,.-- --- ,.. ... ,..++. - ,- .- ,-. . ,-. . ,--..._ ,. -.,.- - ,- .. ,- t_.... x._.... ..u.av.....u. ...a .J c-ii...-a: ,sr : s.,....... --. ,-- .- ---.u+ --.. ,--. .-. --..v+.+. --- ,-- ..- ---..+.a...+. ---. ,-. -- -..+.au...u --- ,--. .--. ---.auu + --. ,-- .-. -- o o . oooo .38. ......... . . . . . . . .. . . . .. . . . . . .. .. . .. ...... araaa . . . . . .. . . .. . . . .. . ... . . ... . . .. . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . .. .. . .. . . . . . . . . . . ... . .. ..... ........ . . . .... . . . . . . . . ... . . .. . . . . . .. .. . .. ..... .... .. . . .. . . . .. .... . .. . . . . .. . .. . .. . . . . .. . .. . . .. . . . . . .. .. . .. . . . . . . . . . . . . . . . . . ..... . . .. . . . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . ..... . . . . ... . . . . . ..... .|c . . . . . . . . . . . . . . . . . .. . . .. . . . . ... .... ... :.. ......, . . . .. . . . . .. . .. .. .. . . . . . .. . . . . . .. . . . . .. . ... .. .. . . . . .. . . . . . . . . .... . . . .. . .. . . .. . . . . . . . . .. . . . ........ +v . . . u+-.- -- .a +.. -.- .. au..a .u +. ..a.u ,.....,. v....,.,..... s. r.._,.... r i..._....+ ....._.. . ......... .......... +......... . +... .. ......+ ... +...+. ..,....... u. x... u..... :aa..:. + . v . + au .+ .u . + . . . ...a .u .++.+. ..u. .v. +. -- . . . . .. +. .++.+...a .u .. -. ,. au .u, .. .... .. u.. + a..+ ...+...+ . uauv+ .. au . .a .u :. vuo i......._ .... . ...... .... .. .... ..+ ......... ...._. .,... ........ o.... ,..., .....+....o..... vuo :a.a- .... . i... x. x.,.. r . ..........+ ......._ ,.... ..... ,.,..... ...., . i.... u......., _..+.... ,.-:s:aa i x.... u..... :aas:as : *, *, *, *,*40 v .aaau +...a. + . .a a. v . au v. .v a+au++...v. .. .v+...a.aaa..auu .+..+.a.a. a+.au - .u .a ao...... c.... r,...... ,ocr u+v..+.. a+......+. +...+.. va +.+.u .au..+. -.. .u+....u+ . + ,- au . . . . +. ,-. a .+ ... . . . ,.. +. v . u ... v. . + +.a +.v .u+... aau.+.+ .v..a+. ....u.a .v..+.+ .+..+ru. a.auv .a..vv a. .a.. aa+ | . .au+ a aa+...u . +a u .+.. +ru. a..+. ..u .. +a . : Discrete Choice Experiment (DCE), , , Abstract How to attract new doctors to work in rural areas: Using Discrete Choice Experiment (DCE)Nonglak Pagaiya*,, Viroj Tangcharoensathien, Tinnakorn Noree*,, Sanya Sriratana*,*Human Resources for Health Development, International Health Policy Program, Thailand (IHPP)As a crucial component of a health system, the shortage of health workforce could deteriorate healthoutcomes. Though newly graduated physicians entering the rural areas every year, the turnover rate ofrural physicians was as high as 11% of rural physicians. It is thus crucial to explore strategies to attract andretain physicians in rural areas. This study was a cross sectional study with 255 physicians serving inyears 1-3 from 9 provinces included in the sample. Job preference was assessed using the Discrete ChoiceExperiment (DCE) method, which involved asking subjects to indicate their preference between 2 hypo-thetical jobs, one rural and one urban. Each job was characterized by 7 job attributes. A total of 211 physi-cians responded, with females (57.8%) responded slightly more than males. The majority of subjects wasfrom an urban background (83%), and graduated from a regional university (63%). There were 24% ofo o . oooo . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012aa.... . .. . ... .. . .. . . . . . -.-... ... . .--. . . .. . .. -. . . .. .. . . .. . . -. . -. . . .. .. . . ... ..... . -. . .. . . . ... .... . . . . . -.. ... -.. . . . . . . . . ... . -. ...... .. . ... .. ... . . .--. .. ... .. ..- . .. . . . . .. . . . s,,., s. . . .. . . .. . ...s. .... ... . . . . . . . . -.. -.. -. .-.. . .. . . . .. . ...... ..... . . . . . . . . . . . . .. . .. . . . .. . .. . .... . ... .. . . . . ... .. .. . physicians under the rural recruitment project. In relation to their job preference, all attributes were foundto be statistically significant in determining the decision to choose a job in a rural area. The results showedthat high salaries, workplace close to hometown, small hospital size, less overtime work, opportunitiesfor specialty training and faster career promotion were important for young physicians to choose ruralposts.The results suggested that the combinations of salary increase, specialty training opportunities, re-duce overtime work, and accelerated promotions seem to be good policy candidates to attract and retainphysicians to rural areas.Key words: Discrete Choice Experiment (DCE), health workforce, physicians, rural retention, Thailanda o o . oooo .42... . . . . . . .. .. . . ... . . .... . . . a.aaraa.+a . ....... -.raase .aa . . . .. . .. .. . . . . . . - . . . . s...... ... .,..., . . . . . ... .. . .. . . . . . ..- .. . . .. .. .. - .. .... ... . .. . ..a aa aa. a aa s aa . . .. . .. . . . ... .... ... .,..... ... ... -,. . ....-.. -,. -... . . .. . .. . . . . . ... ... . . .... . .. . . .... ... . . ... . ... . . .....a.a. a s aa . . ... ........ .,... -,... :. . ....., .. .. . . .. . ... .. . . .. . .. ... c -.. . ... . . . . . .. .. . . . . .. . . . . .. .. ...aaaa.asaan . . . -.- . .. -.. . . . . . . . . . .. . . . . .-- . . . . . . - ........ .. . . . . -. . . . . .Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012a a +a.u a. ,.-- . a ,- ...u +.aa... +.aa...a+a+ .a+v . ..a +v +.. .. .+a+ .+a+.v. / auu.+. . . ..++ru.+. . .va+ . -a+aa + +.a+. ocr . . +..aaaa uer - ... .. .. . . .. .. .. .. . . . . . . . . ... . . . . . . . .. . . .. .. .... .. . .... .. c-.. . . .. . . .. . . . . . .. . .. .. . . . . . . .. . . . .. +.u+.+..+. ,r...... c............vvv+ov.aaa ,x-~-- aa.++. . v . .- v .. -. v --a+u.a...aaa .....aav.. .. . . aa .-va .--. -a aa aa .. .... -.s. +. -.. .avaaavaaa+++ .+a+.... -. o o . oooo .44 . . . .. . . . ,- . .. . . . . . . . . . . .. . .. . . . . . .. ... .. .aaaeeeanaa . . . .. . . +.+. ocra a oaa. a.:. ,sr ci r .|a-aa+v........... ,...... ...... -. ,-. -.-. .- --..ua ,v.a. -- ,-- --. -.- ----.u+... ,v..... ... ,-.- -.. .--- ---.au. . ,v..a+v. . ,-. .... -..- ---.au. .- ,v..a+v. -.. ,--- ..-. --. ---.au. . ,v..a+v. ..- ,-. ...-. - ---. .. .+a+ ,v. .+a+ -- ,--.- --.. --- ---..v./auu. ,v... ..-. ,-... ... .-. ---../+.+ru. ,v... -- ,-.- -... . ---..++ - v ,v. . v -- ,--. -.. -- ---aa+v+.ua ,v.a. -. ,--. -.. - ---..u+... ,v..... -. ,-.-. -..-. .- ---. .. .+a+ ,v. .+a+ --. ,--.. --... --- ---..v./auu. ,v... .. ,-.. ..-. .- ---../+.+ru. ,v... - ,-- ---.. ..-- ---.a.avu.+vvv+oaaaaa ,v.. --. ,---- -. -- ---.a. ,v..+. ... ,--. -. .-- --+..a+.. ,v.v. -- ,-.-- ---. ..-- -...+.... ,v.... --.- ,-.-- -.. ..-. --.+.a.a. ,.a -- ,-. --. .-- -.+.a.av.. ,.a --- ,-.. --. ..- --..v.. - v ,v. . v . ,-.-- .-.. - ---.Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 .. . . . .. .. . . . ... .. . .. - . . . .. . . . . . . .. .. . . ... .. - .. ... . . .. . ... . .. . . - . . ... ... . . . . . . .- . . . .. . . . .. . .. .... . ... .. . . . . . . . . . ... . .. . . . . . . .. . . .. .. ... . .. . . .. ... . ..... .. . . . . . .. . .. . .. .... . . .. . . . . .... ... . ... . . .. ....... .+ .. ... .. . .. . . . . .. .. ... ..... .. . . . . .+..u+.+..+.auaaaa+ ,aa+vJJa +.v. .+...+v - --. - +a. .- .. --.. . +a. . .- -.-. . +a. .- +a. .. -.. +a. .- .+.+.+ru. ... . +a. .- +... . ... +a. .- .+.+.+ru. ... - .. o o . oooo .46. . . . . . .. . ... .. . . . .. . . . . . .. . .. ... ... - . . . . . . . . . . . . .. ... ... . . .. . . . . . . . . .. . . .. . ... . .. . . .. . . . . . .. . . . .. .. .. . .. . ... ... . . . ... . . .. . . .s,.... -... . .,. . s.. -...... . ... ... . . ... . . . . .. . . ..... . . . . . . . .. . . .-... .. .. .. . . . ... ........ar. . ...... . . . . . . .. . . . .. . . . . . . . .. . . . .. . . . .. . .. . . .. . . ..aaaraa Consortium for Re-search on Equitable Health System (CREHS) UK Department for International Development (DfID). +v . . . u+-.. -. .a +.. -.-- . . . .. .. ..va.. -.. . .u+. .u .a + ..va.. -.. v....,.,..... s. r.._,.... r i..._....+ ....._.. . ......... .......... +......... . +... .. ......+ ... +...+. ..,....... u... x..... u..... :aa..: .u .. ..au...+... .v. .u . . u. -. + . v . + au .+ .u . +. . . ...a.u.++.+Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012. ..u. .v. +. -- .. a . +. .a + v-- ..a. ,.au.u,- x,.. . r..... s u.._ ..,... ....,. . ...... ,......... ........ .... ri :aaa:a,::s.a x,.. o...... ..... .,...... .. ...... .... ri :aa:sa..- t._..+. . r.... r . ..... . ... .,,....... ..+ .......... . +...... ..... .,...... . .... .... ......,..., ........... u... x..... u..... :aa-::.. u... x. i... v u..... .... ,......... .. ,. ......... ..r...,.. ..... .. . +...... ..... .,...... ,i.......,v...._... oc o.._... u......., :aas .,. : ,....+:a.. oo, a , ......... .. ...,//_.._....+./......,/_,/,.,../u...i...a:as,+..- o..... ou. x..... r. x..+..u..... so. x.._ uu .. .... ....., ..+ ......., ......... . ... ..... . ,................. . ....+ ,......... ..+, . ,.._ ,.,..... ..o...., u..... s... x. :a.a:.::-.. x...+ ix u . ... ..... ,. . .......... . .......... r..+.._ .. . +...... ..... .,...... .. .......u..... r.. :a.:a.-:.... s... . r......._ or' ,......... .. ,......., ..+ ..,......., ,. ............. i u..... r.. :aa.::a:-:. v.+... s. s..... o. s... .. r..... r r......... .._...... ,....... ,. . ...., . ,.....,.. ..+ ..... or r.i o.. r.... :aa::a. o+.. . r... i. s.... u + _...... ,............. ..... ,....... r......... .. ,....... ..+ ,. ............. i u..... s... x. r..., :aaa:as. * * . .48 .+ . . . v. u ++ .+ u +..v u . .. + ..u . ..a.+ +.au.u .,u -... +.ua ..u .++ .v .+.auu ..+.a.a . .. .. . +..a.+... aa. ..au -.--- a.v...v...auuv-- .+. .+.. ..au.+. .a++.+...va..,+a+.v -.-. .. - +.....+.u.+. +... . .uv -. v . -. . . . ...+.uv -.-. - a. aa+. a.. . .+.+... . .- +.+ .u . .. . .u ...a++ .. .. v.v..uuv...+. uuv...... -.. .. .+. +... +.u +.... a . ...v -.a. .u.. -.- .. + +. ... +.. . u +. . . .v +..r /. v -. . - ./ u . .. v -. +. ...ur / .a+. ...ru.r /au v -. . r...v -. + ++.v.+.auu...a..: Abstract Effects of increasing hardship allowance on dentists performance in community hospitalsSunee Wongkongkathep*, Komet Wichawut, Jaruwat Busarakamruha, Suriya Rakcharoen*Bureau of Dental Public Health, Department of HealthBureau of Health Administration, The Permanent Secretary office of Ministry of Public HealthFaktha Hospital, Uttaradit ProvinceThe study is aimed at evaluating the recent effects of increasing hardship allowance paid for dentistswho are particularly working in community hospitals. The focused effects were 1) distribution and reten-tion of dentists; 2) hospital financial status; and 3) performance and productivity of dental workforce.o o . oooo . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012aa... . . -. ... . ... . .. -. -... .. . . . . . . . . . . . . ......... . . . . .. . .. . ... . . .... . . -. . .. -. .. .. --.-. . .. . . . -- . ....-.. . . . . . . .. . . . . . . . . . . . . . ... . .. .. . . . . . . . . . .... . . . ... . -- .. . -.. . . .... . . - . . . . - ... -- ....... . . . . - . . .. .......... . .. ... . . ... . . ... . . . . . . . . .. . Overview data was collected from many secondary sources such as dentist personnel database and pay-ment during 2005-2009; dentist mobilization from personnel management database (2008-2010); and den-tal service outcome database in 2008 compared to 2010. Primary data included surveying hospital financeduring 2008-2010 using self-reported questionnaire to 725 hospitals and then interviewing a group of 7senior inspectors in the Ministry of Public Health. The result was revealed that financial measure waslikely to have no impact on distribution pattern or retention of dentist workforce as the mobility foundwas mainly from remote areas to rural areas with better social amenity. Regarding community hospitalfinancial status, paying hardship allowance showed no effect because a budget of 2,750 million baths wassubsidized by the government in 2010. Lastly, comparing performance outcome between 2008 and 2010, itwas found that oral health promotion activities by dental hygienists in 2010 was pushed up to 707 cases/personnel per annual, while basic dental service performed by the dentist showed no difference in theirproductivity.Key words: hardship area payment, financial incentive, oral health services, dentist, district hospital.a o o . oooo .50 . . . . .. .. . . . . . . . . . - . ....a.aaa.... . . . . . .. . . .. .. .-..-- . . .. . ... . -. -. . .. .... .. - .. . . -- . .. .. . -- . ... . -.-. . - . ... . .. .. .. .. . . . -. -. . . . . ..... . .. .aaaaa+aanar e- . . . .. . . . . .. . . . . . . . . .. . ... -.. . .... -- ... . .. . . . .. . . . .. . . - -. ..... . . . . ... . ....... . -.. ... -- . .. . ..... . . . .. . . . . .. -.. . -- .... . . . . . -- . . . . . -.- .. . . . -.--- . - . . -- .. . -. ..... a au +v.v -.---a....ua... a au +v.v -.---a...Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012aaaaaanaaaea.aas. . . . -.-. .. .... . . . . . . . -.. .. -- . .- .-. . .. . . .......... ... .. ....... ... - . ... . -. ... - .. . .. ..... . . ... .... . . . . . . . . . . -. . . . . .. -- -. .- -. . . . ...... .. -. .- -. . . . . - -- .. -.. . ... . . . . . . . . . . .... +auv -..-- a... +auv -..-- a......+... o o . oooo .52aaaasaana. .... . -.- -- .... . . . .. . . . .. -.- . .- -. .. .- -. . ..... . -.- . .. -. .. . -- ... ... . . .. .. .. -.- -.- .. .. -. .. - -- ...... . . . . ....... . -- . araara a+ aa a aa+aanan.r . .. . ... . .. .. .. -- ... .. . . - . . . . ..... -- .. .. . . . . . . . .... . .. - .-.. . . .. +. au . . . . .. a..va..v -. -.a..u .. +. au . . . . .. a ..v a.. v -. -. a..u a .Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 . . . . ... .- .. .. .. - - ... . . . . .. . . . . . . . . . . - . . .. .. -- .. . .- .aaasan.r ..... . -.-. . ... ... - . ..... . .. . . - . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . ...- . . . . . . - . .... . . -.. -. . ... -. . au .. aaa++. u+-.--- .v...v.+...auu+a+ () .-.--- . - ..-.-----.--- -. . ..--.----.--- -.. ... .-.---.-.--- - .- ...--.---..--- .- - .-.---.-.--- .- . .-.---.---..--- .. -- .-----.--- .. . -----.--- . - ---- , . ,, o o . oooo .54. --- ... . ...- ... .... . . .. . . . . . . . .. . . . . . .. . . . ...- . . . . . . .. .... . . ..- . .. . .. . . . . .. . . . . .. . . . . r/u a..u , r/u a..u , r...+ .- . ,a..u r+a./. a..u r a ... a +/u , a..u r +a.. /u ,a..u u.a - uv. .. . .u.a - uv. .. . .u.a - uv. .. . .u.a - uv. .. . .u.a - uv. .. . .u.a - uv. .. . .Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012 .. . . ... a ana n.r a ar . a . . .. .. . . . -. . -. . . . . . . . . .. . . . . . . . . .. . . . ... .. . . - .. .... .. .. . .. . . . . . . -. . .. . . -. . ..- . -.- . - . +r +. .. / a .a..u r + .. / .a..u ... ... . .. . . . . . .. . . +..r+.uvv -. a -.. N= +....r ,. -..- .-.. -..-+...v+..r ,. ..- ..-. ...-.+...ur ,. .-. .. .+...ru.r ,. -.++...v+.. --- --- -.++....u .- - -.++....ru. - . -.u.a - uv. .. . .u.a - uv. .. . . o o . oooo .56 . . . . . .. . . -. . . . - .... -. -. . . . . .. . . .. . . ... -. . .. . .. ... .. . . . . .. . . ..... .. . . . .. . ... . a aaa a a aasan. . . .. -. . ... -. . . . . . -. .. . ... .... . . . . . ... . .. .. .. ..-. . . . . . . . . . . . . -. -. . . .- .... . ... . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . ..... .. +..r+.uvv -. a -. a..u N= N= N= +....r ,. .--- .-- ..- .- ...-. -..- . -..- .-.. -..-+...v+..r ,. ..-- -... ..-- -.. ..- ... .-- ..- ..-. ...-.+...ur ,. .... ... .-. ..-- . - .-. .. .+...ru.r ,. - . .- -.. .- -. -.++...v+.. . -- . --. - . --- --- -.++....u -- . - .. - -- .- .- - -.++....ru. -. - . - - - . -.Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012a.a sa .+aa.aa s s .. . . . . . . . . .... . .. . . ..... . .. . ....aa+aaaaasaana . . . . +..r/. a..a.auvv -. a -. / N= N= N= N= N= N= % % % % % % . .v +.. .. -- ::: ... - .-- .. -: . . :: -. -- .-- . - r /.+. . .. -. .- .: -- -.. : - --- :- ..-.- ..-.. . -. ..--- .s -. -. a-ur /.+..ru. .-. .-- :: .. ... :. -- .-. ss ..- .- :a --. -.- .: .-. . .a:r /au+. . .. ..-. ..-.- .: ..-. ... -a ...- ...-- :aa ..-- ... .s ..-. ... .s- ..--- .... .:r/. +..r+.u a..a.auvv -. a -. () N= N= N= N= N= N= rau . -- -- -. .- .. . .. . - -. -- r . . .- .- .. .. . . -. -- .. .r. . - - - -. . .-. .-- ..- .+....r ..-- -... ..- -.- ....- -.-- ... ... ...- ..-- ..- ..-.+...v+..r ..- ..--- ...- .. ..- ..- ...- .-.... .-.-- ...-.- .-. ..+ --. - .- --- .- -.. --- -. --- -. --- ---+. ..u r - -.- -.. ...- ...-. ..- - ...- + -- .. .. - . . -- - .. .- -+...ru.r .. .-.- .. .- -.. ..... ... .. .... -..-- -..- .-..+ . - . - ... - - - . o o . oooo .58 . . .... . .. . . . . .. .. . . . . - . .... . . . .. . .. . . . . . . . . .aaasan. ... .. . . -. . - .. . . .. . . . . . . . .. . .. .. . . .. . aaarsaanan. . . . . . . . . . . . .. . .araaa ... . . . . . . . . . . . ... . ... . . . . .. . ... . . . .. . . . . . . . . . . . . - . . ... .. . . -. . - . . .. . . .. . . . . . . . . ... . . . . .. . ..... . . . . . . . . . .. . .. . . . . .. . . . . . . . .. ... . ..... . - . . . . . . . . . . . .saaaa. ... . ... . .... .. - .. . .. - . . . .. . . . ....... . .. . ...Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012........aaaraa...... . . . .. . . ....... .. . . ... ... ... .. .. .. .. . .....r. ....., . u......., ...... x.,.. . r..... i........ ...._...... .+...... ...+... ,... :aa. r..... . r..., ..+r.... ....., . u......., ...... :aa: ,i. ...- . . . . + . . . ----/.. . -. u.. -- +..a.vaaauv.. . . . . + . . . --./ , .- u.. -.- +..v+a..a. .. .+.. ---.-.-./ . -- u+. -. +...+.... t... o x......... ..+ ........ . .... ...... ........ .. ..... .... . ... ..+, . +..... .. ......+ r.o.... u......., . t....,. *, *, *, *, *, *,*60 ..+.. . .u u .v . .u. .+.......a... .+ .+... + v .aa. ... .u .+ .. v.u ++ .v . + +. +..a . .. +...a .u u +v .u.... . v .ua....a.u.a .+.. .. .. . . -. a+..+a+.+.. ,o...... c.... r,......ocr .. +. a +.+ . .u + +.. - a . . .. . a v +. .a . . +. . a + a c.+...... ._.... .._....+.+.u.+..+... ..v...av.v. v.+.a +.. . a .. + . a.u. a v +.a....a.aa..+.aa..u..a+ .- . .-. -- +....a . +..+ . + . . .. .+. +. . u .....a+...a..a.a. +. + +.u .. ... a . . .a.a.. u a v... v.+a. +.a. ..a.. aa+ |vu+.|. a a v +... a + .. .a . v+ | ...a . ..a . +..+ . + . . . .+. +.. u... v: , , , Abstract Employment benefit packages to attract health workforce in public health facilitiesNonglak Pagaiya*,, Apichart Chantanitr*,, Sanya Sriratana*,, Krisada Wongwinyou*,, ChirapornLapkom*,, Warangkhana Worarat*,*Human Resources for Health Development, International Health Policy Program, Thailand (IHPP)As the health needs increased, health workforce requirements have been increased too. However,the policy to downsize the civil servant positions implemented has made the Ministry of Public Healthfailed to attract and retain health workforce into public health facilities. This study therefore aimed too o . oooo . Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012aa. . . . .... . . . . . ... . . . . -.. ....... . .. .. . . . ... ...... .. .... . . ... . . -. ... . . . . -. . . . ... . . . . -.. . -..-. . -. .. . . . .. . .. . . . . . ... . .... . .. ... . . -. ... . -. .... ...-.. ... . . .. .. . . . . . . . .... . -. ...... . .. .. . . . . . ... . . . . . .. . . . .... . . . . .. . -. .. . . . . . . . ... . .. .. .. . . . . . . . ... .. . . .. ...assess the factors affecting the health workforces decision making in choosing public health facilities astheir job of choices. A Discrete Choice Experiment (DCE) tool was used and that each health workforcewas asked 16 questions to choose between 2 jobs which have different attributes. The data were analyzedby conditional logistic regression.The findings showed that both financial and non-financial incentives played important roles in healthworkforce decision making to choose their job of choices. Benefit packages that were significantly associ-ated to their choices of non-civil servant positions were: salary increase at 20%-40%, career advancement,opportunity for continuing education, bonus provision, pension fund and a longer employment contract.The results indicated that the government needs to develop the appropriate employment packages thatcould attract health workforce in public sectors. The attractive benefit packages comprise: higher salary,career advancement, opportunity for continuing education, bonus provision, pension fund and longeremployment contract. These packages could be attractive for health workforce to choose to be hired asnon-civil servants.Key words: Temporary employment, Discrete Choice Experiment (DCE), health workforce attrac-tion, public employment benefit packagesa o o . oooo .62 . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . .......a.aaa raa. + a . . .... .. . ..... ... .. . -.raase .aa . . . . .. . ... . . . . . .. . -.-. . . .. . . . . . . . . . .. .. . . .. . . . . . . .. . . .. . . . .. . .... . . . . .... ... . .. .. . . .. .... ... .,..... ... . . . -,. . ... . -.... . . . . . a aa aa. a aa s aa . . . .. .... ... .,..... ... ...-,. . ... -.... . . .. . .. . . . . . . .. . .. . ... . . . .. . . .. .. . . .. . . ..... .. . . . . . .. .. .. . . .. ... .. .. . . . .. .. .. .. .. .. . . - . ... . . . . . . - . ... - .. . . . . . .. .. . . . . . . .a.a. a s aa . . .. . . . . . .. . .. ....... .,... .,... . . . .Journal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012saan uer.. .. ....... .,..... ... . .. . . . .... . . .. . .. .. .. .. ... . ... .. ... ... .. . . . . .. . . . .. ..... . .. .. .. ..... . . . . .. . . . ........ . . ... . .. . . . .. . ... . . - . . . .. ... . .-.. .. .. . . . . . . . . . . . . ... ....... . . . . .. av...+.....+..u.a av++ J - v. a J ~ v. v J . v. a J a.+.a+ ..- +.. .- +.. .v.+ . .. +..a . . +a , . ...... a + ..+. ..+. ..+.a+ ..+.a+.a+ ,.ua .a+ ,...uaa..u v.... v.... v.... v... .+ . + .+.+ .+.+ ..+.+ ..+.+... .v .v .v .va +.. . a +.. . a +.. . a +.. ...a. ... ... .a .a.+.+. .u ..+.+..u . . . . . .+... . u .u+ . . u .u+ . . u .u+a - .... ... . - .... ... +aa.u.u+. .. . . .. a... .a. - .... ... ..... u .. .u.. .. .. o o . oooo .64. .. - . . . .... ... ..... . .. . . . - . . . . .. . . . . ... . ... . . . . .. . ... . . . ... . .. . . .. - . .. . .. ... .. - .. .. . .. . .. . . - . . . . . . .. . - x . - - .. ..... c...,.. ..,... . . . ... .. . ... . c...,.. .., ..... .aaasaa.r. -.. . .... ..- . . . -- . . . . . .. . . .. . . .. . .-. . .. . .. .u ocra a u+ - u+ ~+.a+ .. ...- +.... +.... +... ... . . . . a..u v... +. .v... ..+.+ ..+.+ . + . +. + . +... . v a+.++.v. .+ v a+.++.v...a. ...+a. . . +a .. . +a ..+.+..u ...+.+..u ..+.+..u..+.+..uJournal of Health Systems Research Vol. 6 No. 1 Jan.-Mar. 2012.. . . . . . - . . . . . . . . .. . . . . .. .... .. . . .. . ..... . ... ..... . . - .. . . . . . . .. .-... .. . . . . . . .. . .a.asaar++aaaa uer ... -.. . . .. ....... .,..... . .. . . . .. .. . . . . .. . . . .. .. . . . . .. . . . .. . . . . . . . c ... . . . ... . . c ... . . . .. . - c ... . . . -. .. ...... .. . . . . ... . .. . . . . . . . . . . . . . . . . . . . . . - . .. a a u+ i u+ z+.a+ .. ... ... . . a..u +. . +. ..+.+ ..+.+ . + . +... v a+.++.v. .+..a. ...+a. . . +a ..+.+..u ...+.+..u ..+.+..u au+a +.a+. ocr o o . oooo .66 +. v+.+ +a+. v a+ . vv .J. , . ,-. va .. ,--. .. ,.-. . , .-. ,-.-. < ,-. ~- ,-.~. a. -- v - ,-- - ,----- v . ,--- .. ,---.- v ,.- ,--... v - ,.. -- ,.-...- v - ,.. - ,--.. vvv - ,-- . ,-. < ,-. ~- ,-... aaav.+ .. ,. - ,--+v+ -- ,... - ,--v+ ,... -. ,.---..v - ,-- - ,--. < ,-. ~- ,-.