Medical personnel in the labor market. Features of the labor market and employment in the conditions of different models of the health care market. Medical professionals accessing online job search resources
This spring, the KAUS-Medicine recruitment agency prepared a study assessing the level of wages in production, sales and promotion medicines according to the results of the first quarter of 2017 in the Moscow region, as well as factors that affect the salary of employees of pharmaceutical companies.
Salary level
Employers' salary proposals can be conditionally divided into three levels.
1. Minimum. These are the most common vacancies among the offers of employers, which, as a rule, remain open for a long time. The vast majority of job seekers usually look for a higher level of pay and consider this employment option as temporary, continuing to look for a job with a more decent pay. Nevertheless, the minimum salary level may be of interest to candidates without work experience or those who expect to receive bonuses in the form of free training, career growth, proximity to work, a solid social package, or the fact of working in a well-known company in their autobiography.
2. Average. In this salary range, employers' offers tend to match the salary expectations of most job seekers.
3. Elevated. By offering this level, employers expect to short time attract the best and most qualified employees, who are likely to be subject to additional requirements (extensive work experience, additional education, knowledge of foreign languages, willingness to work overtime, etc.).
Concerning general position on the labor market in the pharmaceutical industry, analysts at KAUS-Medicine note that 2016 was quite a depressive year for it: market growth slowed down by half, and that was inflationary growth. That is, not the turnover of production increased, but only the volume money supply in this sector. However, the current geopolitical situation, according to experts, plays into the hands of Russian pharmaceutical companies and drug manufacturers from the EAEU. In 2016, domestic manufacturers received strong support in the form of a decision to limit government purchases of imported medicines. The previously developed strategy for the creation of pharmaceutical clusters in the regions of Russia "Pharma-2020" is being successfully implemented. The state is actively investing in the development of innovative drugs and the construction of new production sites, and the latest legislative acts will stimulate foreign companies localize their production sites in our country. Any fluctuations in the production and sales market directly affect and set trends in the labor market in regions and megacities.
Dynamics of demand for specialists
In 2017, Russian pharmaceutical companies stepped up their search for senior staff with extensive experience and knowledge, and ideally with experience in organizing production and development centers abroad. Particularly ambitious players are trying to strengthen the staff of top managers with expatriate leaders. In large pharmaceutical companies, there is a growing need for talented developers and qualified technologists, specialists in organizing contract manufacturing, managers to promote the services of contract sites.
Due to the growth in the number of production sites under construction, the trend of increasing demand for enterprise managers with experience in organizing the work of new industries continues.
Observing some cyclicality in the labor market, KAUS-Medicine analysts predict in 2018-2020. a sharp increase in demand for specialists in the field of promotion, sales of medicines, and along with demand, a decrease in requirements for job seekers and an increase in salaries.
What affects salary
An analysis of the offers of employers in the first quarter of 2017 showed that most positions are characterized by a large spread between the minimum and maximum wage levels.
As experts have found out, the following factors influence the level of wages offered by employers in the field of pharmaceuticals:
Differentiation of pharmaceutical companies in the market(foreign companies, Russian manufacturers, distribution companies).
Various existing salary systems: net salary, salary and percentage of revenue, salary and bonus system.
Specialization of the worker and work experience. The salaries of specialists in the sales department of the hospital and pharmacy areas will differ significantly. A drug registrant with significant track record of successfully obtaining drug marketing authorizations and business relationships with regulatory authorities can expect higher pay levels than a specialist with minimal work experience.
Company's product portfolio(drugs, dietary supplements, medical cosmetics).
Sales volume and company size or structural unit in which the specialist works.
Company pricing policy for marketed medicinal products.
Level of tasks to be solved and area of responsibility. The salary of a manager may vary depending on the coverage of the territory he oversees (for example, only Moscow and the Moscow region or all CIS countries), promoted drugs - OTC or Rx, as well as on the functions performed - support and development of his area of responsibility or start-ups, active development of one of the directions of the company.
According to the results of the first quarter of 2017, there is a decrease in the average salary level for specialists whose activities directly affect the increase in sales (tender manager, key account manager, regional manager). At the same time, demand for them remains, but many employers, due to falling sales, are forced to reduce salaries and expand the list of requirements for specialist competencies and education.
| Position | Annual increase / decrease in salary |
| +13% | |
| analytical chemist | +11% |
| pharmaceutical production technologist | +9% |
| validator | +5% |
| director of quality | +4% |
| pharmacist/pharmacist | +4% |
| national sales manager (national sales manager) | +4% |
| purchasing manager | +3% |
| pharmacy manager | +3% |
| Sales Representative | +1% |
| field force manager (promotion team leader) | 0% |
| head of representation | 0% |
| marketing director | 0% |
| director of pharmaceutical production | 0% |
| pharmacy network manager | 0% |
| medical director | -1% |
| medical representative | -1% |
| Quality manager | -4% |
| medical advisor | -5% |
| tender manager | -5% |
| Sales Manager | -5% |
| key account manager (KAM) | -9% |
| registration manager | -10% |
| Head of Sales Department | -12% |
| Product Manager | -13% |
| Regional Manager | -13% |
Scarce specialties
Based on the analysis of the labor market in the pharmaceutical industry, experts recruitment agency"KAUS-Medicine" made a rating of the most demanded and most difficult to close positions in the pharmaceutical industry.
Top 5 most demanded positions in the pharmaceutical industry in 2017
1. Pharmacist-pharmacist / head of pharmacy.
2. Sales manager.
3. Product manager.
4. Medical representative.
5. Clinical Research Manager.
Top 5 most difficult to close areas in the pharmaceutical industry in 2017
1. Pharmaceutical production technologist.
2. Leaders in the R&D department.
3. Product manager.
4. Regional manager.
5. Key account manager (KAM).
Despite a significant change in the situation on the market in the field of pharmaceuticals, the trends in the demand for specialists in specialties in quantitative terms have not changed, only the search criteria and requirements of employers are changing. Companies seek to optimize personnel costs and reduce costs, which forces them to increase their requirements, expand the functionality of their staff and select more versatile specialists.
Pharmacists/pharmacists have been in demand for many years, and even during the crisis due to the rapid development of pharmacy chains both in Moscow and throughout Russia. Employers offer these specialists low wages at high labor intensity, which leads to constant staff turnover. Pharmacy managers are increasingly combining administrative work with front desk work, and all this against the backdrop of a slight increase or maintenance of the same wage level, so here again the risk of high staff turnover increases.
Since good, experienced “salespeople” with a customer base are in demand by pharmaceutical companies, they themselves are picky in choosing offers, pay attention to the reputation of the manufacturer, the social package offered, the variety of the assortment, the price level, sales conditions, and logistics.
Increasing competition in the market between pharmaceutical manufacturers affects the growth in demand product managers. In the last two years, the requirements for the competencies of these specialists and for the expansion of their functionality have been increasing. Well, since now most employers do not raise salaries, the process of selection and closing of vacancies for product managers is very difficult.
Medical representative- one of the most demanded positions in the field of promotion of pharmaceutical products. Experienced medical representatives strive to find work in well-known large companies with a good social package, an interesting and wide range of drugs, a low level of control. They need professional and career growth, and pharmaceutical manufacturers are not ready to offer it, because they do not want to lose the leading link in promoting their products.
In the list of the most demanded specialists clinical research manager replaced the process engineer, but this is only temporary and is primarily due to the fact that the number of new production sites in Moscow and in the regions has only recently begun to increase, and so far, in a crisis, the services of contract organizations (CRO) are in great demand, because keeping the clinical trials department on staff much more expensive than hiring contractors for this work.
process engineers are still in demand in pharmaceutical industries, but over the past few years, the list of employers' requirements for the qualifications and experience of specialists has expanded significantly. Companies are looking for candidates with narrow experience in the production of certain dosage forms (solid, liquid, etc.). Legislation has changed, most industries have received GMP accreditation.
In terms of search complexity, they are not far behind technologists specialists in the development of new drugs. Some companies attract talented scientists with many developments and their own patents to senior positions in the R&D center, while others are more important to have managerial experience, leadership qualities and serious experience in Russian and Western centers development and research in production.
If a few years ago candidates chose employers in the regions, today the employer already sets the criteria on the labor market - a narrow market allows you to track the reputation of candidates. Also in dealer companies there is a policy of "non-poaching" of specialists. Certain problems with logistics and organization of the work of representative offices have not gone away and have become even more noticeable during the crisis, which complicates the work of regional managers. And all this with a significant decrease in the level of salary offers and an increase in requirements for the competencies of candidates.
In the current difficult economic situation for retailers, the most successful key account managers candidates become good experience and knowledge in the field of sales, with pronounced leadership qualities. This allows them to simultaneously maintain the share of their category of goods on the pharmacy shelves of the chains and at the same time agree on the most favorable conditions for your company and not make concessions that are critical for the manufacturer to pharmacy purchasing specialists. Finding such specialists is not easy, especially in today's market situation, when sales are declining and employers are not able to offer a high level of wages.
Salary plus bonuses
Remuneration of employees of the sales department is usually presented in the form of a salary and a bonus part, depending on the results of sales, the implementation of the plan.
Typical pay systems:
- fixed salary + percentage of sales;
- fixed salary + quarterly or annual bonuses based on sales results.
In large pharmaceutical companies, in addition to monthly or quarterly bonuses, there is also an annual bonus.
Providing a social package to employees of sales departments can be divided into three groups, depending on the policy of companies:
Minimum social package includes:
- mobile phone payment
- reimbursement of travel expenses or provision of a company car;
- training if necessary.
Most pharmaceutical companies provide standard social package, which includes:
- providing a company car;
- car insurance;
- payment for mobile communications, the Internet;
- work laptop;
- food compensation;
- training (trainings, seminars).
The most complete social package occurs more often in large Western companies:
- provision of a company car or reimbursement of travel expenses;
- car insurance;
- payment for mobile communications, the Internet;
- work laptop;
- food compensation;
- corporate training in sales and product promotion;
- on-site trainings (including on-site trainings in far abroad countries);
- accident insurance, life insurance;
- hospitality expenses.
Business training
Working conditions and salaries of large Russian pharmaceutical manufacturers today are as close as possible to working conditions in Western companies. Domestic producers strive to attract the best candidates from the labor market. Thus, trainings are regularly held for employees, which are conducted by both internal training managers and external training companies. The topics of trainings may be related to the peculiarities of drug promotion, presentations, work with doctors, medical institutions, etc. Large Western companies conduct special seminars abroad to get acquainted with the conditions for the production of drugs, as well as field trainings on various topics (team building , customer focus, comprehensive trainings, etc.). Corporate business training for top managers to develop management skills in large Western companies can be equated to obtaining an MBA degree.
The state and issues of employment in the healthcare sector depend on both external and internal conditions. External conditions include the state of the national economy, the fundamental norms and values of society, the level of solvency of the population, its demographic characteristics, and attitudes towards health. For example, for the majority of Russians, health does not have an independent value, but is viewed as a means of achieving other goals and needs of the individual - a higher income, the acquisition of an apartment, etc. Health is subject to severe exploitation, especially in today's economic and social reality. A sociological survey of those employed in the field of small business, conducted in Irkutsk, showed that the need for medical care much higher accessibility to medical institutions. This is largely due to the influence economic factors, and, in particular, the fear of changing attitudes on the part of managers or owners of firms and organizations or, ultimately, losing their jobs. Healthcare in Russia is one of the most neglected sectors of the national economy. In 1996, per capita funding for health care was $8, while in the US it was $2,354, in the UK it was $836, and in Greece it was $375. The ratio of spending on health care and defense as a percentage of GDP is: in the United States, respectively, 14 and 3.5%, in England - 5.9 and 2, in Germany - 9 and 2.8, and in Russia the situation is reversed - 2.6 and 5 .
The internal conditions that determine the state of employment in the health sector are related to the specifics of the product offered to the market, since this determines how the type of market medical services and employment characteristics. There is no unity of views on the question of what acts as a given product - directly health or a medical service. The history of healing does not allow unequivocally assessing this problem. For example, in ancient Egypt, the patient was charged not for the number and time of visits, but for the result: the patient paid with silver for the weight of his hair after illness - if the illness was significant, then the hair grew more. The doctor was economically interested in long-term illnesses, from the point of view of the economy, the volume of medical services was actually paid, with some adjustment for the complexity of the care provided.
On the other hand, in ancient China, physicians serving the elite received salaries as long as the patients remained healthy. The doctor was economically interested in the health of the client, since the state of health itself was paid.
Consideration of health as a commodity is complicated by a number of circumstances:
The absence of a generally accepted definition of "health", which would allow to obtain a quantitative assessment of health;
The need to “exit” to the “price of human life”, which is contrary to traditions and culture (life is priceless).
If health is nevertheless considered as a commodity, then it is possible to determine its place in the process of social reproduction, which will allow, in particular, to establish a certain level of wages medical workers.
Since the patient's health is related to the patient himself, the monetary value of his health is different for different patients, which leads to the need for non-economic regulation in the healthcare sector. For example, already ancient Chinese laws contained provisions on the need for doctors to respond to any call from a patient, high or low rank, rich or poor, about the need to treat them equally and not think about monetary rewards.
Thus, the recognition of health as a commodity requires an active role of the state in regulating the health care market, in addressing issues of the number and structure of medical personnel, the nature of their employment and the level of payment. The labor market for medical workers is not very dynamic, there are no advantages of competition in the provision of medical care, the patient is limited in choosing a medical institution, as well as an attending physician.
If we consider a medical service as a commodity, then the following provisions appear:
The need for the service to meet the quality standard, which is established through the certification and licensing procedure;
Taking into account the special role of the risk factor in the provision of medical services, which is implemented through the insurance procedure.
Since one medical service is poorly substituted for another, a characteristic of the employment of medical workers is a sharp differentiation in the incomes of specialists. A feature of medical services is also the random occurrence of demand, which leads to asymmetry in the relationship between the patient and the doctor.
Thus, if a medical service acts as a commodity, then the market is characterized by liberalism in its organization, medical workers receive a fee for the fact of providing a service. The labor market for medical professionals tends to monopolize, which stems from the asymmetry in the relationship between the patient and the doctor. Insurance plays a special role in the medical services market, which de-monopolizes the market, increases competition among medical workers, and makes it possible to use the advantages of the market. The activities of insurance agencies are being formed and expanded, the labor market of insurance agents directly related to the labor market of medical workers is emerging.
The nature of the health care input product defines the characteristics of the three health market practice models and, accordingly, the specific characteristics of the health worker labor market.
The first model is a market focused on the peculiarity of a medical service as a product. A typical example of such a market is the US medical services market. This market is primarily represented by the private healthcare system. The labor market of medical workers is close to the market of free competition, it is characterized by intense competition, which makes it possible to ensure the growth of the quality of medical services.
The demand for medical services is limited only by the solvency of clients, the doctor is interested in the growth of medical services, which often stimulates the supply of unjustified services to the market. Employment of medical workers is stimulated by fashion and advertising. For example, having a good psychoanalyst in the USA is as fashionable as having an excellent hairdresser or massage therapist. However, advertising performs a positive informational function, because. helps patients in choosing the medical services they need, in addition, in a competitive environment, it stimulates the quality of medical services and highly professional employment. Professionalism is "acquired" by extensive practice. The average workweek of an American physician is 60 hours, of which 45-48 hours are directly involved in clinical activities.
Focusing on the expansion of the medical services market can lead to a crisis of overproduction of certain medical services, which leads to the formation of structural unemployment.
In the second model of the healthcare market, the commodity is health. A typical example of such a market is the UK health market based on the public health system. Within the framework of the health market, through the payment for medical services, the health of the nation is paid for. The state form of ownership of medical institutions dominates, medical and managerial personnel are actually hired state personnel. The state, as the largest owner, imposes on medical institutions and medical personnel a model of behavior that is far from market incentives and stereotypes. This market, being a “quasi-market”, is characterized by extremely overregulated relations between clients and medical workers, as well as various aspects employment of the latter. There are no natural incentives to improve the quality of medical services, which leads to the use of outdated medical technologies. The level of employment and income of medical workers is limited by the economic opportunities of the state, the degree of priority for healthcare, and state standards for medical care. The volume and differentiation of medical services is much less than in the first model of the health care market, which negatively affects the structure of the market for medical workers. The considered model of the health care market is characterized by a slow response to external changes affecting the health of the population and health services.
In conditions state regulation Employment unemployment among the medical workforce is mitigated by relative inefficiency in employment.
The third model of the healthcare market focuses on such a feature of a medical service as the random occurrence of demand for it. Under the item on this market it is health that is understood to a greater extent, since the economic consequences of its violations are insured, but payment for health is made through payment for medical services. A typical example of such a market is Germany, where the medical care system operates within the framework of a social market economy, which also determines the employment model for medical workers.
The interest of society in health as a commodity is associated with state control of the health care market and the employment of medical workers, which reduces the level of market competitiveness.
The concept that a medical service is regarded as a marketable good has not been adopted in any European country. However, market mechanisms are being used in various health sectors, as are competitive incentives to influence the behavior of health workers.
So, although medical services are not considered an exclusive commodity in the health care market, they are explicitly or implicitly present in all three models of the health care market, which allows us to consider the latter in terms of a service approach. The production of medical services coincides in time and space with their consumption, does not leave tangible results, and the utility is assessed by the consumer after production. Unlike other services, it is often not possible for a patient to push back the consumption of health care. The need for medical services is inherent in any individual, regardless of his income level. The sphere of medical services is also distinguished by the special importance of contacts between clients (patients) and employees (medical workers).
A feature of the healthcare sector is the high labor intensity and science intensity of services. For example, in Germany mobile phone for people with a sick heart is connected to a special device, information about the state of human health is transmitted to the central console of the medical institution. Often, the introduction of modern equipment and apparatus in a number of cases does not compensate for the cost of living labor, as is the case in the main branches of material production, but creates an increased demand for additional labor necessary to service new equipment. Equipment medical institutions new equipment involves the involvement of various specialists - engineers, chemists, biologists, programmers, etc. In the area under consideration, labor is still the leading factor of production, and the importance of this labor receives an appropriate economic assessment, which is a factor in the demand for employment in the provision of medical services. In economically developed countries, wages in healthcare are 20–30% higher than in the economy as a whole. The average salary of medical personnel is several times higher than the average for the economy, for example, in Canada - 4 times, in Finland - 2.2 times.
Similar information.
"Trends and Employment Factors in Russian Healthcare"
1. Employment in health care: a theoretical analysis
AT different countries operate various models financing and organization of health care, but many general trends can be traced in the labor market of specialists: an increase in the supply of labor and employment, an increase in demand for medical education, a deepening of specialization, an outstripping growth in the number of doctors compared to the average medical staff (SMP), geographical uneven distribution of workers across territories .
The growth in employment that is characteristic of healthcare in most countries of the world can theoretically be explained by an increase in the demand for labor and / or its supply. On the demand side, such serious factors as the aging of the population, which has affected most countries of the world today, the growing complexity of medical services, requiring additional labor resources. Demand for medical workers is growing, and it does not matter who is the buyer - a profit-maximizing clinic (of which there are few even in developed market economies), or a private non-profit hospital, or a publicly funded hospital. Regardless of the mechanisms and, the employer always has a fixed budget and strives to spend it efficiently. Therefore, when the demand for labor is formed, a more expensive factor of production (skilled labor) can be replaced by a less expensive one. The development of new technologies, which makes work in all spheres of human activity more efficient, and in medicine increases the productivity of the worker, which means it changes the position of the demand curve.
At the same time, the demand for the work of doctors has its own pronounced features:
Ø The consumer in most cases does not pay for medical care himself, the payment is made by a "third party" - a government agency or an insurance company. Therefore, the demand for a doctor's service (and hence the demand for labor) is less price elastic;
Ø Since a significant part of employers in healthcare are organizations of the public sector, wages are not set by the market, but are set by some standards. The state generates demand in its sector by determining both the required number of employees (starting with admission to educational institutions) and wages. This severely limits market forces in health care;
Ø Despite the rapid development of new technologies in medicine, the replacement of labor by capital is possible here only to a limited extent. Health care in this sense is a classic example of an industry where labor and capital are complements rather than substitutes;
Ø To a certain extent, the doctor himself can form the demand and prices for his services, that is, the demand cannot be considered exogenously given and determined only by production technologies, consumer (state) preferences, their incomes and the degree of reaction to price changes.
The supply of labor in health care also has its own characteristics. This is the need for longer training (compared to other professions), which means more investment in human capital. It can be assumed that the return on the investment made is higher, but since wages in health care in most countries are lower or slightly higher than the average for the economy, we are talking about other forms of return - non-monetary, in particular, job satisfaction. The results of treatment are important not only for the patient, but also for the doctor himself. In theory, this interdependence is modeled by directly incorporating the patient's utility into the doctor's utility function.
In health economics, various theories of the behavior of doctors are proposed: models monopolistic competition, price discrimination and others. From a theoretical point of view, the most interesting model is the agency relationship between a doctor and a patient, which explains the formation of supply-provoked demand (SSP). The reason for the emergence of such relationships is the lack of information of the patient, who does not have professional knowledge. In addition, the decision on medical care is often made urgently, in case of a serious condition of the patient, when neither he nor his relatives have time for additional consultations. Therefore, in practice, the doctor on behalf of the patient determines what treatment is needed, and the patient cannot control the decisions of the doctor, willingly or unwittingly trusting him.
The problem is exacerbated by the fact that the patient in most cases does not pay for medical services himself, so he does not actually have a budget constraint that usually restrains consumption. CVD manifests itself in a growing number of doctor visits, procedures, even unnecessary surgeries. As a result, there is a perverse dependence of output volumes and prices on the medical services market, which is not typical for "normal" markets - they grow simultaneously. This allows doctors to maintain and even increase both employment and earnings.
Empirical studies do not provide an unambiguous assessment of the significance of the SSP phenomenon. Early works show the existence of agency relations, later this influence is not detected or is assessed as insignificant. The explanation for this is the spread of insurance mechanisms in healthcare: the insurer begins to control expenses on behalf of the client.
An important characteristic of employment in health care is the ever-increasing wages. Restraining the growth of wages here, as in any other industry, depends on the possibility of replacing living labor with materialized or less skilled and cheap labor. The degree of substitution depends on the prevailing technologies as well as the preferences of the regulator, if any. One of the theoretical models explains the possibility of an increase in the wages of doctors while maintaining and even increasing employment precisely by the preferences of the funding agency (state). The same model clearly shows that such a decision is inefficient from a social point of view (reduces social utility).
The problem of most healthcare systems in the world is the lack of nursing staff. The labor market for nurses has its own distinct differences. Firstly, this is a more mass profession that does not require such a long training. Compensation is correspondingly low, as is the return on investment in training. Therefore, for nurse often it is economically justified to move to another field of activity, where she can partially use her knowledge and skills. Secondly, nursing is a female profession, which influences the decision on the individual labor offer, it is formed under the influence of family factors, and does not depend so much on the level of payment. If the family is complete, then a woman working as a nurse is not the main recipient of income. Many empirical studies show a weak dependence of the decision to work and hours of work on the level of wages. On the contrary, significant factors are the presence of the husband's earnings and the number of children of preschool age.
Like any labor market for mass specialties, the SME labor market should be analyzed taking into account geographical differentiation. The availability of regional healthcare systems in the SMC varies significantly even in relatively small states, and even more so in countries with a significant geographical extent. The situation on the local labor market - average per capita income, unemployment rate and relative (rather than absolute) wages of nurses - may be important factors in individual labor supply.
An analysis of theoretical models and empirical studies allows us to draw several general conclusions regarding the formation of employment in health care:
· Employment of health workers is growing all over the world, specialization and accompanying wage inequality are deepening, and there are significant geographical differences in the level and conditions of employment. The level of employment can be determined by the preferences of the funding agency (state) and maintained (increased) simultaneously with the growth of wages to the detriment of social efficiency.
· Demand and supply in the labor market of doctors have their own characteristics. Demand can in certain cases be induced by supply from the physician. The supply of labor is determined not only by standard factors (wage rate, value of free time, unearned income), but also by moral factors - the utility of the consumer and other non-monetary characteristics of work. Hence the weaker dependence of labor supply on wages.
· The labor market for SMEs is significantly different from the labor market for doctors. This is a more mass and “female” profession, here the factor of investment in human capital is less significant and it is easier to change the scope of employment. Therefore, the labor supply of nurses does not depend so much on the absolute wage rate, it is largely determined by family factors.
In our study, we tried to check to what extent these features are typical for the Russian labor market in healthcare, and what are its differences.
2. Employment trends in Russian healthcare: an empirical study
The assessment of the situation on the labor market in Russian healthcare was carried out on the basis of available information provided by Rosstat, the Ministry of Health and Social Development, as well as on the basis of Russian monitoring data. economic situation and Family Health (RLMS) over the years.
Industry statistics (Rosstat)
First of all, it must be said about general dynamics of doctors' employment. In Russia, where the relative number of physicians has traditionally been very high since Soviet times, this figure began to decline slightly after 1990. However, since 1995 it has been constantly growing: if we compare the number of doctors per 10,000 people in 2005 with 1991, it increased by 15%. Over the same period, despite a steady decline in the country's population, the absolute number of people employed in the health sector as a whole increased by 11%, and the share of health workers in total employment increased from 5.6% to 7.1%.
As for the structure of employment of doctors by specialty, in Russia, approximately the same trend is visible as in Western countries - deepening specialization: In 2005, the number of physicians per 10,000 population was exactly the same as in 1990, while the total number of physicians increased.
Geographical uneven distribution of medical personnel across the territory over the past 10-15 years, not only has not decreased, but continues to deepen: in 2006, with average population 49.4 doctors per 10,000 population, the regions with the best medical staff were almost twice as high as the average - these are St. Petersburg (83.5), Chukotka Autonomous Region (81.6) and Moscow (78.6).
And if in terms of the relative number of doctors, Russia is one of the first places in the world, then the proportion “number of nurses / number of doctors” in our country is much lower than in most developed countries. In the US, this ratio is approximately 3.7:1, in the UK - 5.3:1, in Finland - 4.5:1, in Norway and Canada - 4.7:1. In Russia, this indicator has been stable since the early 1990s. at the level of 1.5, which indicates about inefficient structure employment- very often a doctor, in fact, has to perform the duties of a nurse "part-time" with his main functions.
Concerning investment in education, the same trend is characteristic here as in many other professional fields. If the demand for secondary vocational education and graduation from medical colleges, having decreased in the early 90s, remain approximately stable, then higher medical education is growing: the number of students in medical universities from 1990/91 to 2006/07 academic year increased from 193 to 204 thousand people. As a result, the supply and employment of doctors in the health care labor market is growing, and the imbalances associated with the shortage of nursing staff are deepening.
As you know, the demand for certain types of vocational education is an indirect indicator of the attractiveness of this profession and future work. In this regard, of particular interest is such an important characteristic of employment in the health sector as wage. There is a widespread opinion in Russia about the low salaries of doctors who do not compensate hard labour, and are the cause of the poor quality of medical care, lack of staff, widespread shadow payments in this area, etc. Indeed, the salary of Russian doctors is significantly lower than that of specialists in many other areas who also received higher professional education. Wages in the health care industry as a whole fluctuated over the ten years from 1995 to 2005. from 60 to 70% of the average salary in the economy (for comparison, in 2004, according to the ILO in the US, this figure was 105%, in the UK - 98%). However, although salaries in healthcare are significantly lower than the Russian average, and doctors in this indicator lag behind specialists of the same level in many other industries, the gap has narrowed in recent years. From 2000 to 2006, the average monthly nominal accrued wages of workers in health care increased 6.07 times, and in the whole country - 4.83 times. As a result, the ratio of the average for healthcare and the average for the economy reached 76%. And if in the Russian economy the regional gap in the wages of the population falls slightly, then in healthcare it is shrinking at a significant pace.
Characteristics of employment in health care according to dataRLMS
The general analysis of health statistics was supplemented by a study based on microdata from the RLMS database (RLMS) with 10 waves of observations over 1 year. All working respondents were conditionally divided into "doctors" and "non-doctors". The first group included doctors and SMPs, the second - all the rest. On average, the share of "doctors" was approximately 4.5 - 5.75% of the employed, and about % of them worked for the state.
Interestingly, unlike their foreign counterparts, Russian healthcare workers work less, on average, than other workers in the economy. Data for years show that the actual duration of their working week has gradually increased all these years, but has always remained 2-3 hours lower than the average for other workers.
In addition, it turned out that medical workers have significantly higher than other professions, average duration of work in one place ( employment stability). In the sample as a whole, this indicator slightly decreased over the observed period - from 8.14 years in 1994 to 6.86 years in 2005. For “medics”, it was about 2 years higher, and over the last observed year it even increased to 11.11 years. This may indicate low competition in the health care labor market. Wages in the industry are poorly differentiated, geographic mobility of the population is low, so the place of work rarely changes. We can also assume a greater return on specific human capital in this area of employment, since a trusting relationship with a patient, reputational factors are important for a doctor, and when changing jobs, they are lost.
It is important to note the age of a worker - in healthcare it is on average higher than in the economy as a whole, and is growing at a faster pace, although “aging” in Russia is typical for workers in all industries. Yes, from 2000 to 2004. the average medical worker has "aged" by 1.4 years, and the average worker in all other professions - by 0.3 years. The "aging" of workers may, in turn, be one of the reasons for more stable employment - mobility, as is well known, is more characteristic of the young.
More stable employment of health care workers is indirectly evidenced by answers to the question about the possibility of losing their jobs: it turned out that representatives medical professions much less, in comparison with other respondents, worries about the prospect of unemployment. It would seem that in a situation of an excessive number of doctors by world standards and a growing graduation from medical universities, there should be competition for jobs in the labor market. However, this does not happen - workers medical specialties and work less intensively than other professions and are less afraid of losing their jobs.
The relationship between the actual hours of work of "medical workers" and the hourly wage rate of their work turns out to be rather weak - the correlation coefficient is less than 0.2, although the relationship remains positive in general. This is not surprising, because in public institutions health care, where most doctors work, salaries are set on a time basis and are fixed in monthly terms. Obviously, salary in this situation is not a serious motivating factor.
At the same time, to the question about the subjective assessment on a nine-point scale of one's financial position physicians in all waves of observations from 1994 to 2005. rated their condition slightly higher than the rest of the workers. Thus, the subjective assessment by physicians of their own financial situation turns out to be higher than the objective assessment of their nominal wages in relation to the average for the economy. This phenomenon can be explained by the fact that doctors are mostly women, and often they are not the first worker in the family (if the family is complete). The financial situation is assessed by them as the situation of the household, therefore, if there are more high earnings other family members it is better. This circumstance serves as another indirect confirmation of the fact that salary as such in this area of employment does not play such an important role in labor motivation.
Thus, the results of a study of health worker employment based on RLMS microdata show that it is characterized by
more stability;
shorter actual working week;
· a longer duration of leisure, which, as is known, has an independent value (especially for women, who are in the majority in this area of employment);
• possible compensation for lower wages by the earnings of other family members.
Determinants of employment in health care (based on data from the Ministry of Health and Social Development and Rosstat)
On the next step research, we tried to determine what factors affect the level of employment in labor markets in health care. We singled out two categories of workers separately: doctors and paramedical personnel (SMP). Rosstat provides data on the number of these categories of workers for all regions of Russia, so we could compare the number of employees with individual indicators of regional development. Data on the salaries of healthcare workers are presented by Rosstat in a generalized form, without breaking down into categories. Therefore, to assess the salaries of doctors and SMEs separately, we turned to the data of the Ministry of Health and Social Development. Unfortunately, since these indicators are not mandatory for statistical accounting, the sample of regions was reduced to 50-60 in different years.
Employment of doctors and ambulances was estimated on the basis of relative indicators - per 10,000 people. The salaries of doctors and SMPs were normalized in relation to the average salary in the region. Indicators of nominal wages in rubles are not very informative due to strong differences in the cost of living across regions, while a relative indicator can differentiate regions precisely from the point of view of the position of workers employed in medicine.
In the course of the econometric analysis, the dependences of two indicators - the relative number of doctors and SMEs in the region - on such factors as the wages of these categories of workers in relation to the average, the unemployment rate and GRP per capita were considered. Due to the limited data sample (number of regions), one-way regressions were built for each year from 2000 to 2005 inclusive. Regression analysis showed the following results:
· Relative wages are not a factor that attracts more workers to the region, and this applies to both doctors and SMEs. The regression coefficients for the relative wage factor are either insignificant or significant, but negative. Apparently, there is an inverse relationship - regions that are provided with medical workers to a greater extent pay them worse, and less well-off - better. In conditions of predominantly budgetary financing of health care, wages are determined by the level of employment, and not vice versa.
· Contrary to expectations, the unemployment factor turned out to be insignificant in the equations for the employment of the NSR. Only in 2000 and 2005 for nurses and in 2001, 2002, 2003. for physicians, it was significant, and the regression coefficient was negative. Thus, it cannot be said that the higher unemployment rate in the region is keeping people in health care jobs.
· For all years of observation and for all categories of workers, the GRP per capita factor is significant, and the regression coefficient is always positive. This result can be explained, first of all, by higher budget expenditures on health care in “rich” regions, as well as by the attractiveness of these regions for the residence of medical workers. This may partly offset relatively low salaries, as well as informal co-payments from wealthier patients.
Testing the Hypothesis of the Existence of Supply-Triggered Demand
We tried to test the well-known SSP hypothesis on Russian data. To do this, we used the approach proposed in early work V. Fuks, and turned to data on the number of surgical operations and the number of surgeons per 100,000 population by region, provided by the Ministry of Health and Social Development. Following Fuchs, we tried to include in the estimation equation the number of therapists per 100,000 population and income indicators - the average per capita money income in the region and GRP per capita. We tried to understand whether the number of surgical operations performed per 100,000 people depends on these factors. The data were taken initially for all regions of the Russian Federation for 2006, then in the course of the work several explicit outliers were excluded - for example, Moscow, St. Petersburg and the Chukotka Autonomous Okrug, where the number of doctors is twice as high as the average for Russia.
The correlation between the number of surgical operations per 100,000 people and the number of surgeons per 100,000 people in the region as a whole is low - 0.26. However, a clear pairwise correlation was found between the regressors: GRP per capita and average per capita income (cor = 0.85), the number of surgeons per 100 thousand people and the number of therapists per 100 thousand people (cor = 0.86), which indicates the presence of multicollinearity. Therefore, indicators of GRP per capita and the number of therapists per 100,000 people were excluded from the regression. The equation took the following form:
where is the demand for the services of surgeons (number of operations per 100,000 people);
Supply of surgeons (number of surgeons per 100,000 people);
Average per capita cash income in the region (an indirect indicator of the possibility of co-payments by the population).
Evaluation of equation (1) for 73 regions showed the significance of the regression as a whole and of both regressors (- at the 10% level, - at the 5% level, R2= 0.25). The dependency takes the form:
(7,00) (2,73) (2,95)
and allows us to draw the following conclusions:
o Demand for surgeons is positively related to the willingness of patients to pay for surgery or Additional services, medicines, etc., related to them.
o Demand for surgeons is positively related to their relative numbers in the region. The latter can theoretically confirm the presence of SSP, but can only mean a more complete satisfaction of the objective needs for operations in those regions where there are more surgeons.
o The coefficient on the variable "number of surgeons" is relatively small - literally, it means that the appearance of one additional surgeon per 100,000 people in the region increases the number of operations performed by only 32 per year per 100,000 people. Taking into account the dimensions of variables, the coefficient at the factor of average per capita income is relatively high. It means that an increase in the average per capita income of the population by an average of 1,000 rubles per month will lead to an increase in the number of operations by 140 per year per 100,000 people. This means that the factor of per capita monetary income is more important in determining the demand for the services of surgeons.
The study of theoretical models of the labor market and empirical works known in modern economy health care, as well as estimates based on available statistical data for Russia, allow us to draw a number of general conclusions.
· Russia, as well as developed market economies, is characterized by an increase in the employment of medical workers, their average salary is below the average for the economy, and the salary of a doctor is often lower than the salary of workers of comparable qualifications, which is offset by greater employment stability. In addition, Russian healthcare workers are characterized by a shorter working week, which also acts as a compensating factor for relatively low wages. In this sense, Russian medical workers differ significantly from their Western counterparts, who work much more intensively.
Among the features of the labor market in health care, they note the ability of doctors to form the demand for their services themselves, as well as the presence in some cases monopoly power manufacturer. However, Russia is characterized by a rather different situation, represented in theory by the model of maintaining the employment of medical workers in the face of growing budget expenditures of the funding agency. In those regions where the relative employment of doctors is higher, their relative salary is often lower, and vice versa. We are dealing, rather, not with a seller's market, but with a buyer's market, and wages under given budget constraints are determined by the level of employment achieved. It was not possible to unequivocally identify the presence of SSP for Russian conditions: the relative number of surgical operations, although weakly correlated with the number of surgeons, is largely determined by the factor of average per capita cash income of the population. The demand for the services of surgeons positively depends on the willingness of patients to pay for operations (officially or unofficially) or for additional services and medicines associated with them, that is, it is formed by the buyer (in this case, not only the state, but also the patients themselves).
· Some features of the Russian labor market have been revealed that do not fit into the framework of models known in theory. Formal analysis of the data showed that relative salary is not a significant factor motivating employment. Although the salary of medical workers is objectively lower than the average Russian level, their subjective assessment of their own financial situation is higher than the average. Obviously, this circumstance is explained by the gender composition of those employed in health care, most of whom are women. Their relatively low wages are partly offset by the earnings of other members of the household and longer leisure time.
· a significant factor determining the employment of medical workers (both doctors and SMPs) was the gross regional product per capita. On the one hand, this confirms the presence of a buyer's market: the more funds in the regional budget, the greater the costs and employment in health care (the higher the demand for labor). On the other hand, for the medical workers themselves, regions with a more developed infrastructure and provision with local public goods are more attractive, which usually accompanies a higher level of GRP. This can partially offset relatively low wages (increases labor supply). It is also possible that doctors and nursing staff are guided not so much by official salaries as by the possibility of "grey" earnings (shadow co-payments from wealthier patients), which will always be higher in richer regions.
Fuchs V.R.
Grytten J., Sorensen R. Type of contract and supplier-induced demand for primary physicians in Norway. Journal of Health Economics, pp. 379–393.
Shields M., M. Ward. Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. Journal of Health Economics, 677-701; Skatun D., E. Antonazzo, A. Scott, R. F. Elliott. The Supply of qualified nurses: a classical model of labor supply. Applied Economics, Jan 20, 2005v. 37 i1 p57(9)
Shields M.A. Addressing Nurse Shortages: What Can Policy Makers Learn from the Econometric Evidence on Nurse Labor Supply? The Economic Journal, 114 (November), F464–F498, 2004.
Elliott R.F., A.H.Y. Ma, A. Scott, D. Bell, E. Roberts. Geographically differentiated pay in the labor market for nurses. Journal of Health Economics, 190-212.
WHO (2006). Working Together for Health. The World Health Report.
Fuchs V.R. The Supply of Surgeons and the Demand for Operations. The Journal of Human Resources, vol. 13, No. 0, Supplement (1978), pp. 35-56.
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Formation of the competitiveness of enterprises of the private healthcare system
or abstract of the dissertation for the degree of candidate economic sciences specialty 08.00.05 - Economics and management national economy"State Research Institute for System Analysis of the Accounts Chamber Russian Federation» |
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Annotation: The article discusses the features of the functioning of the labor market of medical personnel working in healthcare institutions of the Moscow region. At present, this region has both specific features of the functioning of the labor market, and properties that are characteristic of the whole of Russia. The article identifies the main problems personnel policy health care of the Moscow region in terms of economic, legal and social factors. The issues of providing the territory with medical specialists, as well as the staffing of medical organizations with personnel in accordance with the approved staffing standards are analyzed. Methods for the rational use of human resources in the health care system of the region are proposed.
Key words: personnel management, labor motivation, human resources, healthcare.
WAYS TO INCREASE THE EFFICIENCY OF THE LABOUR MARKET OF MEDICAL STAFF IN THE MOSCOW REGION
The article examines the functioning features of medical staff labor market in the Moscow region. Nowadays this region has both peculiar features and characteristic common for all Russia. The article highlights the main problems of personnel policy of health care in the Moscow region from the point of view of economic, legal and social factors. Furthermore, there are also analyzed the questions of penetration of the territory by medical experts, and also the completeness of the medical organizations staff according to the approved regular standards. To conclude, the author offers several methods of rational use of personnel resources of health system of area.
Key words: HR management, motivation, human resources, health care.
The labor market is a system public relations, reflecting the level of development and the balance of interests achieved for a given period between the participants present on the market: employers, employees and the state.
The issues of the labor market of medical workers are the most relevant today.
Staffing problems have been an important part of state policy for many years, including in the field of healthcare. At the same time, many issues of personnel policy require further in-depth study.
The peculiarities of the labor market in health care are the specific training of medical personnel, the presence of a very narrow specialization of workers, and the continuous professional development of sufficiently experienced personnel. Also, the labor market in healthcare is characterized by the fact that there is no unemployment on it, there is a constant shortage of labor resources with a full staffing of healthcare organizations. The degree of intensity, the amount of work performed, as well as the income of medical workers depends on the features of the implemented system of compulsory medical insurance.
A feature of the Moscow region is a significant amount of commuting labor migration of the workforce.
Due to the higher salary level provided by the package social services, proximity and transport accessibility, up to 30 percent of the economically active population of a number of districts of the Moscow Region adjacent to the capital are employed in organizations in the city of Moscow.
In turn, the Moscow region remains quite an attractive region for qualified labor resources from other constituent entities of the Russian Federation, mainly from the regions that are part of the Central federal district, as well as countries of the Commonwealth of Independent States (CIS) and far abroad. This is due to the relatively higher standard of living of the population of the Moscow region.
The number of labor resources of the Moscow region is more than 4 million people, of which the medical staff working in the health care institutions of the region is almost 110 thousand people.
The effective development of the health care system in the Moscow Region largely depends on the state of the professional level and quality of training, rational placement and effective use medical and pharmaceutical personnel as the main health resource.
Medical assistance to the population of the Moscow Region is provided by 495 state, municipal and private healthcare institutions, including 2 research clinical institutes. More than 50,000 beds have been deployed to provide inpatient medical care in the Moscow Region, and the planned capacity of outpatient clinics is almost 138,000 visits per shift.
Strengthening and expanding the network of healthcare institutions in the region, equipping them with the latest equipment and medical equipment contributes to improving working conditions. Purposeful measures are being taken to increase the salaries of healthcare workers, laws of the Moscow Region have been adopted, providing for measures on preferential payment for living space and utilities health workers certain categories. At the municipal level, additional decisions are made to improve the social protection of healthcare workers at the expense of municipal budgets.
However, there is a shortage of about 40 percent of the medical workforce against the background of an increase in the medical staffing rate. In the Moscow region, there is an increase in the number of medical personnel: the number of doctors increased during 2015 by 1514 people, paramedical workers - by 1244 people. The number of obstetricians-gynecologists, anesthesiologists-resuscitators, doctors of clinical laboratory diagnostics, neurologists, neonatologists, ophthalmologists, pediatricians, district doctors (therapists and pediatricians), surgeons, traumatologists-orthopedists, radiologists, oncologists, doctors of other specialties). The number of nurses, district nurses, midwives, paramedics of the ambulance service has increased.
In accordance with the Moscow Regional Program of State Guarantees for the Provision of Free Medical Care to Citizens, the standard for providing the population with doctors is 34.8 (persons) per 10,000 population, and the standard for providing the population with paramedical workers is 68 per 10,000 population. The staffing rate for medical personnel remained at the level of 2014 - 31.6 in 2015; nurses - increased from 66.3 in 2014 to 71.2 in 2015.
The provision of the population with doctors of clinical specialties remained at the level of 20.9 due to the increase in the population of the Moscow region. The ratio of doctors and nurses was 1:2.25. The part-time ratio of medical workers decreased from 1.55 in 2014 to 1.49 in 2015.
Staffing of full-time positions of doctors -89.6% (2014 - 89.9%), nursing staff 92.4% (2014-93.1%) shortage of doctors decreased from 43.8% in 2014 to 39.9% in 2015 and amounted to 15429 units, including: - in outpatient clinics - 37.3% (8024); - in stationary institutions - 37.9% (5453); - in the ambulance service - 56% (1156); - doctors of district therapists - 37% (1015); - doctors of district pediatricians - 25.6% (411).
In 2015, there was an increase in paramedical workers - the shortage of paramedical workers decreased by 2.4% and amounted to 33.7%. Taking into account compatibility, the number vacancies is: - doctors - 3583 positions; - paramedical workers -5920 positions. Despite the achieved high growth of individuals in medical and paramedical personnel, there remains a high proportion of working medical workers of retirement age (doctors - 30.9%, paramedical workers - 25.2%), which will create prerequisites for a further increase in the existing deficit. In this regard, the task of reducing the part-time coefficient of medical workers to the recommended level - no higher than 1.3 becomes especially urgent.
In order to reduce the shortage of medical personnel, cooperation continues with seven higher educational medical institutions for targeted training of medical personnel for the Moscow Region: First Moscow State Medical University named after I.I. THEM. Sechenov, Russian National Research Medical University. N.I. Pirogov, Moscow State University of Medicine and Dentistry, Ryazan State Medical University. Academician I.P. Pavlov, Tver, Ivanovo and Yaroslavl State Medical Academies.
For admission in 2015 to the above seven medical universities, the Ministry issued and issued 1205 target directions to applicants (2010-596). According to the results of entrance examinations for study at the above higher educational institutions in 2016, 343 students were admitted (in 2010 - 146).
In 2015, 290 graduates of higher medical educational institutions, of which 161 were registered for internships (in 20 specialties), and 129 were sent for training in the target residency.
Peculiarities of providing healthcare personnel in the Moscow Region predetermine the need for the formation of additional mechanisms for securing personnel in the workplace, the development of contractual relations between the employer and graduates of higher and secondary medical educational institutions, as well as specialists with work experience, in the interests of the functioning of the industry.
Quality qualification level personnel, their professional training and retraining plays a special role in the conditions of modernization and structural reform of health care.
In 2015 on qualification categories 1869 doctors and 6423 paramedical workers were certified (2014 - 1927 and 6415). The share of medical workers who passed certification was 10.3% (doctors - 8.1%, paramedical workers - 12.65%). The share of doctors with qualification categories of the total number of doctors was 39%, and of paramedical workers - 60.3% (2014 - 40% and 63.2%). The strategy for the development of the system of additional professional education is based on the need for training, retraining and advanced training of personnel, taking into account the restructuring of healthcare, its needs for specific specialists. The volume of postgraduate training of personnel should be formed on the basis of relevant orders from health authorities and institutions.
The main task for the coming period is the organization of postgraduate training for the development of the institution of a general (family) practice doctor, the advanced training of district therapists, district pediatricians, and district nurses, provided for in the established manner.
The system of quality control of training of specialists at all stages of continuous education should be further developed.
Organization of health workforce management in accordance with the principles and requirements of modern scientific management theory by human resourses, and at the present stage is necessary condition conservation and development human resources health care of the Moscow region, taking into account the peculiarities of its staffing.
The effectiveness of the personnel policy and the health workforce management system directly depends on maintaining a high professional level of the management team, forming a reserve of managers with the necessary organizational skills and modern knowledge in the field of management.
The need to conduct a comprehensive system analysis of the structure, activities and provision of all parts of healthcare with human resources, taking into account both their quantitative composition and the quality of training, requires increased coordination management activities at the regional and municipal levels.
One of the most important areas of activity affecting the retention and successful replenishment of medical personnel is the further improvement socio-economic status and standard of living of health workers.
A necessary condition for increasing the motivation of specialists for a qualitative result of labor and attracting highly qualified personnel should be considered to improve the quality working environment, which includes issues of wages, the creation of appropriate working conditions and the use of working time.
The strategic direction of reforming the remuneration system in health care is preparation for the transition to sectoral remuneration systems, the construction of which is based on the transition from estimated financing to financing according to the final result.
Currently, the course of modernization is being completed in the health care system of the region. Measures are envisaged to strengthen the infrastructure of medical organizations, introduce modern medical and information technologies. There are new requirements for the provision of the healthcare system of the region with medical personnel - their number, composition, intra-resource ratio.
According to the study, in the dynamics of observation, an imbalance was revealed between the volumes of the number of medical (increase) and nursing (decrease) personnel.
Regular staffing of institutions with medical personnel is often ensured by combining posts. The availability of primary contact doctors (district) is decreasing. Nevertheless, the staffing situation in terms of the availability of district pediatricians in the region is more favorable, there has been an increase in the absolute number of working general practitioners.
The analysis shows that a huge shortage of personnel remains in the healthcare industry, which is further aggravated by a significant imbalance in personnel: between primary care physicians and medical specialists, between medical and diagnostic doctors, and between doctors and paramedical personnel.
The Health System Modernization Program being implemented in the Russian Federation was a kind of indicator that revealed serious problems with the provision of qualified personnel to medical organizations. In the conditions of re-equipment of medical and preventive healthcare institutions with new modern equipment, the introduction of new technologies, standards and treatment protocols, there is a shortage of professionally trained medical workers.
The shortage of personnel remains, despite the fact that practically all measures of social support for medical workers have been preserved in the Moscow Region.
It seems absolutely timely that the decision was made to develop a set of measures to provide the healthcare system with medical personnel, which provides for the adoption in the constituent entities of the Russian Federation of programs aimed at improving the qualifications of medical personnel, assessing the level of their qualifications, gradually eliminating the shortage of medical personnel, as well as differentiated measures of social support. medical workers, primarily the most scarce specialties, in accordance with Decree of the President of the Russian Federation dated May 7, 2012 No. 598 “On improving the state policy in the field of healthcare”.
In addition, it is proposed to introduce a new approach to the medical personnel planning system, by legislatively obliging graduates of medical and pharmaceutical universities who studied on a budgetary basis at the expense of the state, including in targeted areas of subjects, to work in any state or municipal institutions health care for three (possibly five) years.
Thus, in order to increase the efficiency of the labor market for medical workers in the Moscow Region, it is necessary to: optimize the planning of the staffing and structure of health personnel, improve training and continuous professional development medical workers, effective management of human resources for healthcare.
Bibliography
1. Decree of the Government of the Moscow Region dated December 26, 2014 No. 1162/52 "On the Moscow Regional Program of State Guarantees of Free Medical Care for Citizens for 2015 and the planned period of 2016 and 2017" http://mz.mosreg.ru/dokumenty/zakonoproektnaya -activity/
2. Materials of the Collegium of the Ministry of Health of the Moscow Region “On the work of the healthcare system of the Moscow Region in 2015 and tasks for 2016” http://mz.mosreg.ru/struktura/kollegiya/
3. Medical personnel: main directions for improving postgraduate training / Tutorial- Etc. No. 3 dated November 27, 2013 _2014 30s.
Any country forms its own labor market and its own system labor relations taking into account the peculiarities of the national economy, social traditions and a number of various factors.
There are models of labor relations that go beyond the national and cover a number of countries.
1. European (continental) model, it is often called social democratic. Its characteristic features:
· High level of legal protection of the employee.
· Harsh rules labor law focused on saving jobs.
· Strong trade unions, the existence of institutions of workers' representation.
Industry tariff regulation
High statutory minimum wages
· Relatively small wage differentiation. This model is more used by European countries. It provides a high level of social security.
· Support for weakly competitive workers through subsidies to firms.
Support for employment in socially significant sectors of the economy
· Creation of special jobs within the framework of the state employment promotion program.
· Implementation of a “policy of solidarity” in wages to achieve equal pay for equal work regardless of financial condition certain firms;
· Supporting less profitable firms and curbing the profits of more efficient firms, leading to equalization of wage levels in them;
· Unemployment benefits are paid subject to the simultaneous retraining of a person for his subsequent employment.
2. Anglo-Saxon model (USA, Canada, Great Britain, Australia, New Zealand). She has the following features:
· Greater similarity of labor and civil rights.
· Decentralization of legislation on employment and assistance to the unemployed.
· Employer's freedom to hire and fire.
· Collective-contractual regulation mainly at the level of the company, not the industry and the region.
· Weak distribution of in-house training of personnel.
· Very high territorial and inter-company labor mobility, especially in the US.
· Higher wage differentiation.
This model has no small advantages: jobs are created more dynamically; the unemployment rate is lower; higher economic growth rates.
Japanese model. Its properties:
· For a significant part of the employees, there is a system of labor relations, which are based on the principles of "lifetime employment", in which the employment of a permanent employee in the company is guaranteed until he reaches the age of 55-60 years.
· Salary and size social payments depends on how long the person has been with the firm.
· As a result of long-term relationships, the potential of women is most effectively identified and used, so their price discrimination is minimal.
· Valid efficient system selection of personnel for investment in human capital and promotion.
· Intra-company patriotism, which allows using such methods of motivation that are not applicable in other countries.
· An increase in wages by 10-20% in connection with the onset of significant events in the life of an employee.
· If it is necessary to reduce production, the staff, as a rule, is not fired, and part of the workers is transferred to other enterprises or the working hours are reduced for them.
· The difference in wages is not large: the lowest-skilled worker receives only 4 times less than the highly skilled one.
· The unemployment rate is low, in the range of 2-3%.
· The regulation of labor relations mainly takes place at the level of enterprises, where there are various trade union organizations that operate at the level of corporations.
At present, the situation in the labor market in Japan has changed: international competition has intensified, and the degree of risk in business has increased.
And the last Chinese model of labor relations. She is characterized by:
· Harsh regulation of labor relations in the public sector.
· Complete absence legal regulation in the private sector.
Low cost of labor, allowing to achieve success in price competition in foreign markets.
Labor surplus in many parts of the country
· The industriousness of the population, whose morality has evolved over the centuries under the influence of Confucianism.
· Availability of free economic zones that help attract foreign investment and advanced technologies.
Distinctive feature Russian labor market is that a significant part of employers and the self-employed, as well as a small part of employees, operate in the shadow mode. economic activity.
The shadow economy is an unrecorded economic activity which includes:
Legitimate economic activity that is not included in official statistics and is not subject to taxation
· Illegal, deliberately concealed economic activity.
According to various expert estimates, the value of products and services produced in the informal sector of the economy in the 1990s ranged from 20 to 50% of GDP.
Such a large spread of shadow economic activity is explained by high costs, including those associated with the costs of starting a legal business, its maintenance, and the protection of property rights in an inefficient state for paying taxes. The informal economy selects a significant part of the country's labor force. It employs more than 25 million people, i.е. more than 30% of the economically active population of the country.
Informal employment has its advantages: it helps to ease social tensions associated with unemployment, low income from legal activities and the uncertainty of future income, and contributes to the growth in the production of goods and services in demand by society.
In the informal sector, three main types of employment can be distinguished according to the degree of legal formalization of employment relations:
1. Quasi-formal employment (a contract is concluded, but rather for appearances, for inspection authorities; it does not protect the employee, does not give him an illegal status, nor labor code RF benefits and guarantees)
2. Informal hiring based on a verbal agreement (especially common in street and market trade, in the field of individual services, when hiring immigrants).
3. Self-employment, carried out in Russia mainly in the informal sector of the economy.
One of the features of the Russian labor market can be called the massive spread of secondary employment - voluntary (permanent or temporary) paid labor activity carried out in free time from the main work.
There are some disadvantages in the shadow economy: more than 25 million people are employed in the informal economy. this is more than 30% of the economically active population of the country. But there are also pluses: it weakens the social tension associated with unemployment, low income from legal activities, and contributes to the growth in the production of goods and services in demand by society.
