OBJECTIVES

Financial incentives strategy is commonly used by many policymakers worldwide for retaining healthcare workers in rural areas. However, little is known regarding the evidence of financial incentives in developing countries especially in dentists. This study aims to investigate the effect of Hardship Allowance (HA) payment on retaining dentists in rural areas in Thailand.

METHODS

The study used longitudinal retrospective cohort study. The annually report of dentists’ resignation during 2003 to 2017 were collected retrospectively. The data of dentists in 2013 was used to calculate the active dentists during 2003 to 2013. The resignation data of dentists from 2003 to 2017 were combined with data of dentist from 2013 to 2017 to analyst the effect of HA on resignation rates of dentists. The resignation rate of dentist was compared before and after 2008, which is the year that the government implemented HA.

RESULTS

From 2003-2017, there were 3,132 dentists resigned from health facilities under MoPH. Data showed that most of them were female 47.4 % and aged between 30-39 years 45.6%. The resignation rate from Northeastern region was the highest rate at 46%. The average resignation was 5.56% per year. The percentage of resignation was increasing from 4.2% in 2003 to 5.8% in 2008. The resignation rate decreased after policy implementation in 2009-2010 at 3.04% and 3.76%, respectively. Before 2008, resignation rate in rural areas and in urban areas was 3.82% and 2.25%, respectively. After the HA implementation the resignation rate in rural and urban areas was 3.27% and 2.07%, respectively.Regression analysis showed that after 2008 dentists in rural areas were less likely to leave the communities significantly (95% CI, -2.00,-0.63, p<0.001).

CONCLUSIONS

This study provides evidence on HA influenced to retain dentists in rural areas in Thailand. However, the effect was in short term, more studies of factor related these patterns is required.