Health labor policy: comparative analysis of Russian and international developments

The Russian health sector has accumulated a lot of serious labor problems, the most important of which are: a low level of labor planning, the shortage of physicians and other medical workers, substantial disproportions in their structure. The objective of this paper is to compare some aspects of health labor policy in Russia and Western countries. Three major developments are addressed: 1) the ways to enhance physicians efficiency, 2) the search for the optimum level of physicians specialization, 3) the changes in division of labor between various professional groups of medical workforce. The comparison of these developments allowed to determine substantially different types of health labor strategies in Russia and Western countries and to look more critically at the major strategic and regulatory documents in the Russian health sector. First, Russia differs much in terms of the size of physicians remuneration, its structure (the share of basic part is lower), as well as in the legal status of outpatient doctors. Second, contrary to Western countries where some efforts are made to overcome the excessive specialization of physicians, in Russia this process is escalating, particularly in primary health care. The overspecialization of PHC contributes much to its understaffing, low quality and dissatisfaction of patients. Third, the process of division of labor between physicians, medical nurses and allied health workers is intensively developing in Western countries, while in Russia this process is very slow. Some new categories of medical workers that support physicians are not known in Russia. Therefore the need for physicians is very high. Practical recommendations for health labor policy are made regarding each of the above developments.