Skip to main content
Top
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study

Authors: Tongtong Li, Trudy Lei, Fiona Sun, Zheng Xie

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

To strengthen rural health workforce, the Chinese government has launched a series of policies to promote the job satisfaction of village doctors since the health sector reform. The purpose of this mixed-method study is to describe village doctors’ job satisfaction under the context of health sector reform and investigate the associated factors.

Methods

Data was obtained from a survey of village doctors across three Chinese provinces in 2014. Using a multistage sampling process, quantitative data was collected from village doctors through the self-administered questionnaire and analyzed by multilevel logistic regression models. Qualitative data was collected through face-to-face semi-structured interviews on both village doctors and health managers. Theoretical coding was then conducted to analyze qualitative data.

Results

Among the 1221 respondents, 48.6% felt satisfied with their job. Older village doctors with less of a workload and under high-level integrated management were more likely to feel satisfied with their job. Village doctors who earned the top level of monthly income felt more satisfied, while on the county level, those who lived in counties with the highest GDP felt less satisfied. However, enrollment in a pension plan showed no significant difference in regards to village doctors’ job satisfaction.
Among 34 participants of qualitative interviews, most believed that age, income, and integrated management had a positive influence on the job satisfaction, while pension plan and basic public health care policies exhibited negative effects. Also, the increasing in availability of healthcare and health resources along with local economic development had negative effects on village doctors’ job satisfaction.

Conclusion

Village doctors’ job satisfaction was quite low in regards to several determinants including age, income, workload, enrollment in a pension plan, integrated management, and county economic and medical availability development.
Appendix
Available only for authorised users
Literature
1.
go back to reference Liu Y, Hsiao WC, Li Q, Liu X, Ren M. Transformation of China's rural health care financing. Soc Sci Med. 1995;41(8):1085–93.CrossRefPubMed Liu Y, Hsiao WC, Li Q, Liu X, Ren M. Transformation of China's rural health care financing. Soc Sci Med. 1995;41(8):1085–93.CrossRefPubMed
2.
go back to reference Sun C, Chai W, Zhou Y, Wang Y. Challenges Facing China’s Public Health and Primary Health Care in Health Care Reform. J Vasc Med Surg. 2014;2:e114. Sun C, Chai W, Zhou Y, Wang Y. Challenges Facing China’s Public Health and Primary Health Care in Health Care Reform. J Vasc Med Surg. 2014;2:e114.
3.
go back to reference Sun X, Jackson S, Carmichael G, Sleigh AC. Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ. 2009;18(1):103–19.CrossRefPubMed Sun X, Jackson S, Carmichael G, Sleigh AC. Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ. 2009;18(1):103–19.CrossRefPubMed
4.
go back to reference Wang H, Zhang L, Yip W, Hsiao W. An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs. Health Affair. 2011;30(12):2427–36.CrossRef Wang H, Zhang L, Yip W, Hsiao W. An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs. Health Affair. 2011;30(12):2427–36.CrossRef
5.
6.
go back to reference De GW, Zhao X, Liu S. From barefoot doctor to village doctor in rural China. Washington D; 1992:2–6. De GW, Zhao X, Liu S. From barefoot doctor to village doctor in rural China. Washington D; 1992:2–6.
7.
go back to reference Bailey C, Blake C, Schriver M, Cubaka VK, Thomas T, Martin HA. A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa. Int J Gynaecol Obstet. 2016;132(1):117–25.CrossRefPubMed Bailey C, Blake C, Schriver M, Cubaka VK, Thomas T, Martin HA. A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa. Int J Gynaecol Obstet. 2016;132(1):117–25.CrossRefPubMed
8.
go back to reference Khamlub S, Harun-Or-Rashid M, Sarker MA, Hirosawa T, Outavong P, Sakamoto J. Job satisfaction of health-care workers at health centers in Vientiane Capital and Bolikhamsai Province, Lao Pdr. Nagoya J Med Sci. 2013;75(3-4):233–41.PubMedPubMedCentral Khamlub S, Harun-Or-Rashid M, Sarker MA, Hirosawa T, Outavong P, Sakamoto J. Job satisfaction of health-care workers at health centers in Vientiane Capital and Bolikhamsai Province, Lao Pdr. Nagoya J Med Sci. 2013;75(3-4):233–41.PubMedPubMedCentral
10.
go back to reference Hotchkiss DR, Banteyerga H, Tharaney M. Job satisfaction and motivation among public sector health workers: evidence from Ethiopia[J]. Human Resources for Health. 2015;13(1):83. Hotchkiss DR, Banteyerga H, Tharaney M. Job satisfaction and motivation among public sector health workers: evidence from Ethiopia[J]. Human Resources for Health. 2015;13(1):83.
11.
12.
go back to reference Zhang S, Zhang W, Zhou H, Xu H, Qu Z, Guo M, Wang F, Zhong Y, Gu L, Liang X. How China's new health reform influences village doctors’ income structure: evidence from a qualitative study in six counties in China. Human Resource Health. 2015;13(1):26.CrossRef Zhang S, Zhang W, Zhou H, Xu H, Qu Z, Guo M, Wang F, Zhong Y, Gu L, Liang X. How China's new health reform influences village doctors’ income structure: evidence from a qualitative study in six counties in China. Human Resource Health. 2015;13(1):26.CrossRef
13.
go back to reference Ding Y, Smith HJ, Fei Y, Xu B, Nie S, Yan W, Diwan VK, Sauerborn R, Dong H. Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China. B World Health Organ. 2013;91(1):64–9.CrossRef Ding Y, Smith HJ, Fei Y, Xu B, Nie S, Yan W, Diwan VK, Sauerborn R, Dong H. Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China. B World Health Organ. 2013;91(1):64–9.CrossRef
14.
go back to reference Li T, Lei T, Xie Z, Zhang T. Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example. BMC Health Serv Res. 2016;16(1):42.CrossRefPubMedPubMedCentral Li T, Lei T, Xie Z, Zhang T. Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example. BMC Health Serv Res. 2016;16(1):42.CrossRefPubMedPubMedCentral
15.
go back to reference Zimmermann KF, Tatsiramos K, Giulietti C. Incentive Problems in China’s New Rural Pension Program: Emerald Group Publishing Limited. 2013. Zimmermann KF, Tatsiramos K, Giulietti C. Incentive Problems in China’s New Rural Pension Program: Emerald Group Publishing Limited. 2013.
16.
go back to reference Feng TY, Dong X. On New Rural Endowment Insurance Demand and its Determinants under the Background of Labor Force Deficiency. Northwest Popul J. 2010;31(6):10–4. Feng TY, Dong X. On New Rural Endowment Insurance Demand and its Determinants under the Background of Labor Force Deficiency. Northwest Popul J. 2010;31(6):10–4.
17.
go back to reference Zhang QW, Li HF, Gao LN. Study on Improving Development Strategies of New Rural Social Pension Insurance System in Heilongjiang Province. J Northeast Agric Univ. 2012;19(4):83–8. Zhang QW, Li HF, Gao LN. Study on Improving Development Strategies of New Rural Social Pension Insurance System in Heilongjiang Province. J Northeast Agric Univ. 2012;19(4):83–8.
18.
go back to reference Zhang X, Fang P. Job satisfaction of village doctors during the new healthcare reforms in China, Australian Health Review A Publication of the Australian Hospital Association. 2016. Zhang X, Fang P. Job satisfaction of village doctors during the new healthcare reforms in China, Australian Health Review A Publication of the Australian Hospital Association. 2016.
19.
go back to reference Zhang X, Bloom G, Xu X, Lin C, Liang X, Wolcott SJ. Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts. Health Res Policy Syst. 2014;12(1):1–9.CrossRef Zhang X, Bloom G, Xu X, Lin C, Liang X, Wolcott SJ. Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts. Health Res Policy Syst. 2014;12(1):1–9.CrossRef
20.
go back to reference Wang L, Wang YQ, You-Ping LI, Shi CH, Yang ZX, Cui-Cui LI, Shen JT, Xiao LI. Performance Evaluation of Primary Healthcare System Reform in Xinjin County, Chengdu City: III. Survey on Human Resources of Village Doctors for Rural Integrated Management between Township Hospitals and Village Clinics. Chin J Evid-Based Med. 2014. Wang L, Wang YQ, You-Ping LI, Shi CH, Yang ZX, Cui-Cui LI, Shen JT, Xiao LI. Performance Evaluation of Primary Healthcare System Reform in Xinjin County, Chengdu City: III. Survey on Human Resources of Village Doctors for Rural Integrated Management between Township Hospitals and Village Clinics. Chin J Evid-Based Med. 2014.
21.
go back to reference Fang P, Liu X, Huang L, Zhang X, Zi F. Factors that influence the turnover intention of Chinese village doctors based on the investigation results of Xiangyang City in Hubei Province. Int J Equity Health. 2014;13(1):1–9.CrossRef Fang P, Liu X, Huang L, Zhang X, Zi F. Factors that influence the turnover intention of Chinese village doctors based on the investigation results of Xiangyang City in Hubei Province. Int J Equity Health. 2014;13(1):1–9.CrossRef
22.
go back to reference Herzberg F. The motivation-hygiene concept and problems of manpower. Personnel Administration. 1964;27(1):3–7. Herzberg F. The motivation-hygiene concept and problems of manpower. Personnel Administration. 1964;27(1):3–7.
23.
go back to reference Xing LY, Xue-Liu LU, Tian XF. A Survey of Influencing Factors to Rural Doctors' Satisfaction in Liaoning Province. Chinese General Practice. 2010;13(4):397–8. Xing LY, Xue-Liu LU, Tian XF. A Survey of Influencing Factors to Rural Doctors' Satisfaction in Liaoning Province. Chinese General Practice. 2010;13(4):397–8.
25.
go back to reference Mu Z. A survey report on the status of doctors' practice in China. China Health Industry. 2011;25:12–3. Mu Z. A survey report on the status of doctors' practice in China. China Health Industry. 2011;25:12–3.
26.
go back to reference Prion S, Adamson KA. Making Sense of Methods and Measurement: Rigor in Qualitative Research. Clin Simul Nurs. 2014;10(2):e107–8.CrossRef Prion S, Adamson KA. Making Sense of Methods and Measurement: Rigor in Qualitative Research. Clin Simul Nurs. 2014;10(2):e107–8.CrossRef
27.
go back to reference Shi L, Song K, Rane S, Sun X, Li H, Meng Q. Factors associated with job satisfaction by Chinese primary care providers. Prim Health Care Res Dev. 2014;15(1):46–57.CrossRefPubMed Shi L, Song K, Rane S, Sun X, Li H, Meng Q. Factors associated with job satisfaction by Chinese primary care providers. Prim Health Care Res Dev. 2014;15(1):46–57.CrossRefPubMed
28.
go back to reference Rasu RS, Iqbal M, Hanifi S, Moula A, Hoque S, Rasheed S, Bhuiya A. Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh. Clinicoeconomics Outcomes Res. 2014;6:515–21.CrossRef Rasu RS, Iqbal M, Hanifi S, Moula A, Hoque S, Rasheed S, Bhuiya A. Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh. Clinicoeconomics Outcomes Res. 2014;6:515–21.CrossRef
29.
go back to reference Xu H, Zhang W, Gu L, Qu Z, Sa Z, Zhang X, Tian D. Aging village doctors in five counties in rural China: situation and implications. Hum Resour Health. 2014;12:36.CrossRefPubMedPubMedCentral Xu H, Zhang W, Gu L, Qu Z, Sa Z, Zhang X, Tian D. Aging village doctors in five counties in rural China: situation and implications. Hum Resour Health. 2014;12:36.CrossRefPubMedPubMedCentral
30.
go back to reference Bloom G, Kanjilal B, Peters DH. Regulating health care markets in China and India. Health Affair. 2008;27(4):952–63.CrossRef Bloom G, Kanjilal B, Peters DH. Regulating health care markets in China and India. Health Affair. 2008;27(4):952–63.CrossRef
31.
go back to reference Jian HU, Biao WU, Management SOP. Status of village health personnel in poverty-stricken minority counties, Guizhou province. Chin J Public Health. 2011;27(5):632–3. Jian HU, Biao WU, Management SOP. Status of village health personnel in poverty-stricken minority counties, Guizhou province. Chin J Public Health. 2011;27(5):632–3.
32.
go back to reference Zhou H, Zhang W, Zhang S, Wang F, You Z, Gu L, Qu Z, Liang X, Sa Z, Wang X. Health providers’ perspectives on delivering public health services under the contract service policy in rural China: evidence from Xinjian County. Biochem Pharmacol. 2014;15(6):1158–60. Zhou H, Zhang W, Zhang S, Wang F, You Z, Gu L, Qu Z, Liang X, Sa Z, Wang X. Health providers’ perspectives on delivering public health services under the contract service policy in rural China: evidence from Xinjian County. Biochem Pharmacol. 2014;15(6):1158–60.
33.
go back to reference Hung L, Shi L, Wang H, Nie X, Meng Q. Chinese primary care providers and motivating factors on performance. Fam Pract. 2013;30(5):576–86.CrossRefPubMed Hung L, Shi L, Wang H, Nie X, Meng Q. Chinese primary care providers and motivating factors on performance. Fam Pract. 2013;30(5):576–86.CrossRefPubMed
34.
go back to reference Chen M, Lu J, Chao HM, Mo H, Fang YM, Mei S. Developing challenges in the urbanisation of village doctors in economically developed regions: A survey of 844 village doctors in Changzhou, China. Aust J Rural Health. 2015;25:1–9. Chen M, Lu J, Chao HM, Mo H, Fang YM, Mei S. Developing challenges in the urbanisation of village doctors in economically developed regions: A survey of 844 village doctors in Changzhou, China. Aust J Rural Health. 2015;25:1–9.
35.
go back to reference Song K, Scott A, Sivey P, Meng Q. Improving Chinese primary care providers' recruitment and retention: a discrete choice experiment. Health Policy Plann. 2015;30(1). Song K, Scott A, Sivey P, Meng Q. Improving Chinese primary care providers' recruitment and retention: a discrete choice experiment. Health Policy Plann. 2015;30(1).
36.
go back to reference Chen LC. Striking the right balance: health workforce retention in remote and rural areas. B World Health Organ. 2010;88(5):323.CrossRef Chen LC. Striking the right balance: health workforce retention in remote and rural areas. B World Health Organ. 2010;88(5):323.CrossRef
37.
go back to reference Xu H, Zhang W, Zhang X, Qu Z, Wang X, Sa Z, Li Y, Zhao S, Qi X, Tian D. Longitudinal study of rural health workforce in five counties in China: research design and baseline description. Hum Resour Health. 2013;11(1):17.CrossRefPubMedPubMedCentral Xu H, Zhang W, Zhang X, Qu Z, Wang X, Sa Z, Li Y, Zhao S, Qi X, Tian D. Longitudinal study of rural health workforce in five counties in China: research design and baseline description. Hum Resour Health. 2013;11(1):17.CrossRefPubMedPubMedCentral
38.
go back to reference Wang J, Su J, Zuo H, Jia M, Zeng Z. What interventions do rural doctors think will increase recruitment in rural areas: a survey of 2778 health workers in Beijing. Hum Resour Health. 2013;11(4):469–75. Wang J, Su J, Zuo H, Jia M, Zeng Z. What interventions do rural doctors think will increase recruitment in rural areas: a survey of 2778 health workers in Beijing. Hum Resour Health. 2013;11(4):469–75.
39.
go back to reference Li X, Cochran C, Lu J, Shen J, Hao C, Wang Y, Sun M, Li C, Chang F, Hao M. Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou. Int J Health Plann Manage. 2015;30(1):E42–55.CrossRefPubMed Li X, Cochran C, Lu J, Shen J, Hao C, Wang Y, Sun M, Li C, Chang F, Hao M. Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou. Int J Health Plann Manage. 2015;30(1):E42–55.CrossRefPubMed
40.
go back to reference National Health and Family Planning Commission of the People's Republic of China. 2013. Further improve the village doctors' pension policy and improve village doctors' salary. National Health and Family Planning Commission of the People's Republic of China. 2013. Further improve the village doctors' pension policy and improve village doctors' salary.
41.
go back to reference Fan CC, Wen LI, Economics SO, University S: New Rural Pension System,Lineage Networks and Households' Intergenerational Transfers in Rural China. Social Sciences of Beijing; 2015. Fan CC, Wen LI, Economics SO, University S: New Rural Pension System,Lineage Networks and Households' Intergenerational Transfers in Rural China. Social Sciences of Beijing; 2015.
42.
go back to reference Wu D, Wang Y, Lam KF, Hesketh T. Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open. 2014;4(12):e6431.CrossRef Wu D, Wang Y, Lam KF, Hesketh T. Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open. 2014;4(12):e6431.CrossRef
43.
go back to reference Seo HS, Kim H, Hwang SM, Hong SH, Lee IY. Predictors of job satisfaction and burnout among tuberculosis management nurses and physicians. Epidemiol Health. 2016;38:e2016008. Seo HS, Kim H, Hwang SM, Hong SH, Lee IY. Predictors of job satisfaction and burnout among tuberculosis management nurses and physicians. Epidemiol Health. 2016;38:e2016008.
44.
go back to reference Association CMD. White paper on Chinese physician practice. 2015. Association CMD. White paper on Chinese physician practice. 2015.
45.
go back to reference Wei Q. Surveying the factors to influence the degree of satisfaction on job of county doctors in rural Western China. Chin Health Serv Manag. 2013;30(1):70–2. Wei Q. Surveying the factors to influence the degree of satisfaction on job of county doctors in rural Western China. Chin Health Serv Manag. 2013;30(1):70–2.
46.
go back to reference Naimoli JF, Perry HB, Townsend JW, Frymus DE, Mccaffery JA. Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach. Hum Resour Health. 2014;13(1):1–13. Naimoli JF, Perry HB, Townsend JW, Frymus DE, Mccaffery JA. Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach. Hum Resour Health. 2014;13(1):1–13.
47.
go back to reference Zhu YP, Miao YU, Yang FQ, Zhou JD, Yang J, Zhao Q. The feasibility of developing a syndromic surveillance system in rural China: A case study of two counties in Jiangxi province. Chin J Health Policy. 2013;6(4):60–5. Zhu YP, Miao YU, Yang FQ, Zhou JD, Yang J, Zhao Q. The feasibility of developing a syndromic surveillance system in rural China: A case study of two counties in Jiangxi province. Chin J Health Policy. 2013;6(4):60–5.
48.
go back to reference Bloom BG. Health policy during china’s transition to a market economy. In: Guald R, editor. Comparative health policy in AsiaPacific. Maidenhead: Open; 2005. p. 23e47. 2005. Bloom BG. Health policy during china’s transition to a market economy. In: Guald R, editor. Comparative health policy in AsiaPacific. Maidenhead: Open; 2005. p. 23e47. 2005.
49.
go back to reference Meessen B, Kashala JI, Musango L. Output-based payment to boost staff productivity in public health centres: contracting in Kabutare district, Rwanda. B World Health Organ. 2007;85(2):108–15.CrossRef Meessen B, Kashala JI, Musango L. Output-based payment to boost staff productivity in public health centres: contracting in Kabutare district, Rwanda. B World Health Organ. 2007;85(2):108–15.CrossRef
50.
go back to reference Liang LZ, Zhao Feng LV, Wang XY, Yang J, Song XX. Enlightenment of Beijing Village Doctor-patient Relationship in the Barefoot Doctors Period to the Contemporary Rural Doctor-patient Relationship. Chinese Medical Ethics. 2012;25(1):60–2. Liang LZ, Zhao Feng LV, Wang XY, Yang J, Song XX. Enlightenment of Beijing Village Doctor-patient Relationship in the Barefoot Doctors Period to the Contemporary Rural Doctor-patient Relationship. Chinese Medical Ethics. 2012;25(1):60–2.
51.
go back to reference Liu X. The Characteristics and Transformation of Chinese Rural Culture. Theory Modernization. 2014;64(64):487–95. Liu X. The Characteristics and Transformation of Chinese Rural Culture. Theory Modernization. 2014;64(64):487–95.
52.
go back to reference Gu S, Liu J, Li H. The Transformation and Reform of Urbanization in China. China Popul Today. 2013;6:42. Gu S, Liu J, Li H. The Transformation and Reform of Urbanization in China. China Popul Today. 2013;6:42.
Metadata
Title
Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study
Authors
Tongtong Li
Trudy Lei
Fiona Sun
Zheng Xie
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0560-8

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue