Job preferences and trade-offs in rural health workforce retention: a discrete choice experiment from western China

The shortage and uneven distribution of primary healthcare workers in rural China have long persisted, with many studies focusing predominantly on salary and working conditions improvement. A discrete choice experiment involving 183 rural primary healthcare workers in Sichuan Province revealed the critical role of Bianzhi (a state-controlled employment system) in workforce retention. Findings demonstrated that Bianzhi dominated job preferences (β=0.964), with practitioners willing to sacrifice 18.2% of their monthly income to exchange for it. Beyond Bianzhi, near location, housing allowances, opportunities for continuing education, and children's education support significantly influenced job choices. Female workers exhibited 1.189 times greater sensitivity to workplace proximity than males (P < 0.001), while those with school-age children required 12.64% additional compensation for remote postings. Policy simulations indicated that combining Bianzhi with children's education support outperformed salary incentives alone. The study advocates optimizing rural healthcare workforce strategies by narrowing the gap between Bianzhi and non-Bianzhi positions, complemented by gender-sensitive and family-friendly measures. For other LMICs, it highlights the importance of understanding the true needs of health workers with different employment statuses.