The Outcomes of Introducing the Effective Contract with Medical Staff

The paper presents the results of a study of changes in the salary schemes and working conditions of medical staff, their labor motivation and the compliance of these changes with the objectives of the so-called “effective”, performance-based, contract being introduced. The data from a set of surveys of employees at public medical facilities in 2009–2018 served as the empirical base of the study. It is shown that the introduction of the effective contract had changed the role of factors determining the salary of medical workers. Whereas earlier qualification had been the leading factor, afterwards it was the volume and quality of the work performed as well as the outcomes of a given medical institution or unit. Most doctors had increased the amount of work they do, and the secondary employment of medical staff had slightly been reduced. Survey data indicate quite a stable hierarchy of labor motives among medical workers, the leading ones being earning money, professional interest in work, and altruism. In 2018, the role of the guaranteed employment motive was elevated. Among the positive changes are an increase in the satisfaction of medical workers with the salary, conditions for advanced training, and rules of remuneration. The identified outcomes are generally consistent with the objectives of introducing the effective contract, and they allow one to argue that the new salary scheme has had a positive impact on the labor motivation of medical staff. However, the conclusion of an effective contract was noted by only half of respondents. For the rest, it all boiled down to an increase in salary. These results indicate serious failures in the administration of this reform.

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