Introduction
The declaration of Alma Ata in 1978, issued by the WHO, emphasised on the significant role of primary healthcare (PHC) in reinforcing the health systems of all countries.1 Consequently, the Iran Ministry of Health and Medical Education (MoHME) promoted the PHC approach due to its venerable values including equity, universal access to health services and community involvement. As a result, national implementation of PHC network began in the early 1980s with a great emphasis on delivering basic health services including immunisation, family planning, prenatal care and environmental health through community health providers in rural areas.2
The comprehensive expansion of PHC network in rural areas improved the health indices dramatically and led to considerable reduction in infants, mothers and newborn mortalities.3 4 This positive result has led Iranian health policymakers to apply a suitable model for continuation of PHC. For this reason, family medicine (FM) has become a main prerequisite of providing PHC and was introduced as a main reforming strategy to ensure the delivery of high-quality and efficient health services.5 Accordingly, FM project was initiated in 2005 for rural population of the health network, and then expanded in to cities with below 20 000 populations.6 The establishment of FM in rural areas improved public access to healthcare services while lack of similar organised model in urban areas caused significant obstacles in accessibility to required health services at a reasonable and fair cost.7 8 This led MoHME to pilot family physician (FP) project in some of the urban areas including Fars in the south and Mazandaran in north of the country in 2012 with the goal of expanding the project for the entire urban population. Despite the anticipated generalisation of the programme, there are still important problems in this way which necessitate appropriate administrative planning and active contribution of various stakeholders.9
To overcome the issue, the number of physicians in areas below 20 000 inhabitants increased to more than 6000 after implementation of FP programme. Furthermore, their salary has increased from US$150 to US$1500 per month.10 Despite considerable efforts in this direction, current status of the programme is still far from ideal. Among some of the challenges considered for FM programme, lack of permanent health workforce especially general practitioners (GP) acts as an important limitation in accomplishing the plan’s objectives. Some of the main concerns of these providers are financial issues, being dependent on insurance institutions as a main source of their payment and lack of facilities in rural areas which motivate them to participate in medical residency exam and leave FM programme.11 Thus, it is necessary to apply an appropriate strategy in order to ensure physicians’ participation and their retention in the programme. Developing an attractive and encouraging FM employment contract is one of the strategies that can thoroughly consider a range of career incentives among GPs.12
Actually, there is a lack of evidence in Iran about types of incentives which improve GPs’ participation in the FM programme. Given this data limitation, we employed a discrete choice experiment as a stated preference approach to address these issues. This study aimed to determine key incentives which were most likely to be effective in improving GPs’ attraction in the FM programme.