The European Journal of Health Economics

, Volume 18, Issue 8, pp 1013–1030 | Cite as

Junior doctors’ medical specialty and practice location choice: simulating policies to overcome regional inequalities

  • Pedro Ramos
  • Hélio Alves
  • Paulo Guimarães
  • Maria A. Ferreira
Original Paper


There are nowadays over 1 million Portuguese who lack a primary care physician. By applying a discrete choice experiment to a large representative sample of Portuguese junior doctors (N = 503) in 2014, we provide an indication that this shortage may be addressed with a careful policy design that mixes pecuniary and non-pecuniary incentives for these junior physicians. According to our simulations, a policy that includes such incentives may increase uptake of general practitioners (GPs) in rural areas from 18% to 30%. Marginal wages estimated from our model are realistic and close to market prices: an extra hour of work would require an hourly wage of 16.5€; moving to an inland rural setting would involve an increase in monthly income of 1.150€ (almost doubling residents’ current income); a shift to a GP career would imply an 849€ increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433€. Our simulation predicts that an income increase of 350€ would lead to a 3 percentage point increase in choice probability, which implies an income elasticity of 3.37, a higher estimation compared to previous studies.


Medical specialty choice Discrete choice experiment Location decision Rural uptake policies Portugal 

JEL Classification

I18 J3 



We are deeply indebted to our colleagues and friends at several medical schools and hospitals across the country for helping us with the logistics for distributing and collecting the questionnaires, particularly to the following MDs: Ana Rita Ramos, André Graça, André Tojal, Bernardo Matias, Carina Mendonça, Carolina Cardoso, Carolina Carneiro, Diogo Dias, Eduardo Palha Fernandes, Elisabete Ribeiro, Flávio Costa, João Felgueiras, João Lopes, João Neves, João Rego, João Sousa, José Pedro Pinto, Luís Coutinho, Luís Magalhães, Luísa Graça, Manuel Abecasis, Margarida Bernardo, Mariana Carrapatoso, Nélson Cunha, Nídia Ramos, Nuno China, Nuno Morais, Ricardo Reis, Ricardo Veiga, Rita Ferreira, Rui Coelho, Rui Malheiro, Rui Lopes. We are also thankful to Antonio Monforte for his initial guidance with the SAS algorithm, and to Professor Rita Gaio for the help with the model analysis. We are also grateful to ACSS, I.P. for valuable statistics of the population of junior doctors our sample represented. We acknowledge valuable feedback from the participants at the 14th Health Economics’ Portuguese Conference and at the European Health Economics Association conference (EuHEA 2016).

Compliance with ethical standards

Conflicts of interest

We have no conflict of interest to declare.

Supplementary material

10198_2016_846_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1. Medical Director Office, Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloUniversidade de São PauloSão PauloBrazil
  2. 2.Faculty of Medicine of the University of PortoUniversity of PortoPortoPortugal
  3. 3.Bank of PortugalPortoPortugal
  4. 4.Faculty of EconomicsUniversity of PortoPortoPortugal

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