The government will increase the share of salaries in the salaries of health workers to 50%

On February 14, during his speech at a session of the Forum of Future Technologies, Vladimir Putin announced an increase in salaries for Russian healthcare workers. From March 1, those who work in hospitals in small towns, regional centers and villages will begin to receive additional payments in the amount of 13 thousand to 50 thousand rubles. From April 1, according to the president, the approach to remuneration of medical workers throughout the country will also change – regions will have to increase the share of salaries in the salary structure to 50%.

In the coming months, salaries for a number of categories of public health workers in Russia will increase. Vladimir Putin announced this on Thursday, February 14, during his speech at the plenary session of the Forum of Future Technologies. The most ambitious measure proposed by the president is to increase the share of salaries in the structure of salaries of medical workers in regional medical institutions to 50%. Let us remind you that now this figure on average across the country does not exceed 40% – this means that only part of a specialist’s salary is paid by the employer under any conditions, while the rest is considered a “variable component” of the salary and can rise or fall depending on the state of the budget specific hospital (see “Kommersant” dated October 9, 2021).

“Additional payments are also important. But medical workers are, of course, interested in the main part, the salary, being higher,” the president noted.

Such a demand, indeed, has been expressed by industry trade unions of medical workers for several years in a row, complaining about arbitrariness in regional hospitals – now in 40 regions the authority to establish wage systems is under the jurisdiction of the head physicians of institutions, in the rest this is handled by local executive authorities. An increase in the share of salaries of medical workers in regional medical institutions could affect up to 2 million people, or approximately 60% of all employees in the Russian healthcare system. As the president explained, it is expected that the government will soon prepare all the necessary documents, and health workers will be able to see changes in their salaries as early as April 1.

“We have long been proposing to fix the ratio of the variable and fixed parts of salaries in the healthcare sector; such a decision would be correct. Another question is how exactly it will be implemented. It is possible to achieve an increase in the share of salaries by reducing the variable part,” sneers the head of the Action trade union Andrei Konoval.

Most of the funds for the salaries of health workers come from the compulsory medical insurance system, not from regional budgets, notes Mikhail Androchnikov, deputy chairman of the trade union of health workers of the Russian Federation. “Compulsory medical insurance, in turn, is financed from employers’ insurance contributions – and if they are not increased, there will be no additional funds. This means a transfer is needed directly from the federal budget, but we don’t know its size yet,” he argues.

In addition to changing the structure of salaries for medical workers, Vladimir Putin also announced an increase in payments to a number of categories of specialists working in small towns and rural areas.

According to him, in cities where 50-100 thousand people live, doctors will receive an additional 29 thousand rubles, nursing staff – 13 thousand rubles. In smaller settlements, the additional payment for doctors will be 50 thousand rubles, for medical workers – 30 thousand rubles. These funds, we note, will be formalized as a special social payment, which the federal budget began paying to most primary care workers in 2023. Now their size ranges from 4.5 thousand to 18.5 thousand rubles. (see “Kommersant” dated December 8, 2022). Increased payments to doctors will be accrued retroactively in April for March. As Andrei Konoval notes, in addition to increasing the size of payments in small localities, it would make sense to expand the circle of their recipients, including staff not only from district and interdistrict hospitals.

In addition, Vladimir Putin recalled the equalization of tariffs for the provision of medical care in cities and rural areas, which will allow regional heads to spend more money on doctors’ salaries. It should be noted that on February 14, the Ministry of Health published a draft government decree that will increase the share of expenses on salaries of specialists employed in centers for the provision of high-tech medical care, some of which are also under the jurisdiction of the regions.

Taken together, the measures proposed by the president look like another step towards increasing wages in Russian healthcare – however, the scale of these changes, expressed in money, is still unclear. Let us note that several years ago the government was unable to agree on a more fundamental one-time change in the remuneration system in healthcare, which required approximately 500–600 billion rubles. from the federal budget annually. Now, according to Rosstat data for January-September 2023, doctors in the Russian Federation receive an average of 106 thousand rubles, which is 195% of the average salary in the economy, medical staff – 52 thousand (96%).

Anastasia Manuilova