Annotation: The article discusses the features of the functioning of the labor market 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 staffing medical organizations personnel in accordance with the approved staff standards. Suggested methods rational use human resources of the health care system of the region.
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 of social relations that reflects 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.
Labor Market Issues medical workers are the most relevant today.
Problems staffing have been an important part of government policy for many years, including in the field of health care. At the same time, many issues of personnel policy need 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 health care is characterized by the fact that there is no unemployment on it, there is a constant shortage labor resources with 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 regions. Russian Federation, mainly from the regions that are part of the Central Federal District, as well as the Commonwealth countries Independent States(CIS) and foreign countries. 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.
Effective development of the healthcare system in the Moscow Region in to a large extent depends on the state of the professional level and quality of training, rational placement and effective use of medical and pharmaceutical personnel, as the main resource of health care.
Medical assistance to the population of the Moscow Region is provided by 495 state, municipal and private healthcare institutions, including 2 research clinical institutes. To provide inpatient medical care more than 50 thousand beds have been deployed in the Moscow Region, the planned capacity of outpatient clinics is almost 138 thousand visits per shift.
Strengthening and expanding the network of healthcare institutions in the region, equipping them the latest equipment and medical equipment contributes to the improvement of 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 healthcare workers of 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, clinical laboratory diagnostics doctors, 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 positions doctors -89.6% (2014 - 89.9%), nursing staff 92.4% (2014-93.1%) the 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 the combination of jobs, the number of vacancies is: - doctors - 3583 positions; - paramedical workers -5920 positions. Despite the high growth individuals of 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 arrived in the Moscow Region to receive postgraduate education and further work, of which 161 were registered for internships (in 20 specialties), and 129 were sent for training in targeted residency.
The peculiarities of the provision of 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.
The quality of the qualification level of 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, from total number doctors accounted for 39%, and paramedical workers - 60.3% (2014 - 40% and 63.2%). The basis of the strategy for the development of the system of additional vocational education the need for training, retraining and advanced training of personnel is laid down, 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 institute of a general (family) practitioner, provided for in in due course advanced training of district therapists, district pediatricians, as well as district nurses.
The system of quality control of training of specialists at all stages of continuous education should be further developed.
The organization of human resource management in health care in accordance with the principles and requirements of the modern theory of scientific human resource management, as well as 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 for a comprehensive system analysis of the structure, activities and provision of all parts of health care with human resources, taking into account both their quantitative composition and the quality of training, requires increased coordination of 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 the improvement of the quality of the working environment, including the 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 preparing 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 exacerbated by a significant staffing imbalance: between primary care doctors and specialist doctors, 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 providing qualified personnel 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 almost all measures have been preserved in the Moscow Region social support for medical workers.
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 new approach to the medical personnel planning system, by legally 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 the training and continuous professional development of medical workers, effective management health human resources.
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 Assistance to Citizens for 2015 and planning period 2016 and 2017" http://mz.mosreg.ru/dokumenty/zakonoproektnaya-deyatelnost/
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.
"Trends and Employment Factors in Russian Healthcare"
1. Employment in health care: a theoretical analysis
AT different countries there are various models of 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 nurses, geographical uneven distribution workers by area.
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 are 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 state-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 the required number of employees (starting with admission to educational institutions) and salary. 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. One can assume a greater return on investment, but since wage in health care in most countries is below or slightly above 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 the health care economy, various theories of the behavior of doctors are proposed: models of 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 in 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 make several general conclusions regarding the formation of employment in health care:
· Employment of health workers is growing all over the world, specialization and its 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. The demand may be certain cases induced by a doctor's suggestion. 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 the Russian Monitoring of the Economic Situation and Family Health (RLMS) data for a number of past 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 somewhat 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 employees 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 The number of medical personnel across the territory has not only not decreased over the past 10-15 years, but continues to deepen: in 2006, with an average number of 49.4 doctors per 10,000 population, the regions best provided with medical personnel were almost twice the average level - this is 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 employment structure- 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 in higher medical education there is an increase: 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. Common in Russia firm opinion about the low salaries of doctors who do not compensate in any way 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. 60 to 70% off 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 length 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 a significantly higher average duration of work in one place than representatives of other professions ( 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 healthcare workers is indirectly evidenced by the answers to the question about the possibility of losing their jobs: it turned out that representatives of the medical professions are much less worried about the prospect of unemployment compared to other respondents. 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 working hours of "doctors" and hourly rate wages for their work is rather weak - the correlation coefficient is less than 0.2, although the positive nature of the relationship as a whole remains. 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, in response to the question about the subjective assessment on a nine-point scale of their financial situation, physicians for 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 higher earnings of other family members, it turns out to be 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)
At the next stage of the study, we tried to determine what factors determine 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 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 the early work of 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 per 100,000 people from 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 of the monopoly power of the 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. Availability of BSC for Russian conditions It was not possible to unequivocally identify: the relative number of surgical operations, although weakly correlated with the number of surgeons, is largely determined by the factor of the 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 by the state, but also by 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 physicians and nursing staff they are guided not so much by official wages 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 of economic sciences, specialty 08.00.05 - Economics and management of the national economy "State Research Institute for System Analysis of the Accounts Chamber of the Russian Federation" |
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Russia's transition to a market path of development inevitably led to the emergence of unemployment, which is an integral feature of a market economy. Under these conditions, we must study and apply the rich experience foreign countries to reduce unemployment and mitigate its consequences, indicating that the position of active employment is absolutely necessary in the labor market, the main goal of which is to facilitate the return of the unemployed to active work as soon as possible through such diverse measures as assistance in finding employment, additional promotion of employment for persons with disabilities in the labor market, organization public works and temporary employment, development of entrepreneurship and self-employment, professional education and counseling.
The attention paid by foreign countries to active labor market programs and the redistribution of a significant share of their resources in favor of these programs (from 0.4 percent of GDP in the US and Canada to 2 percent in Sweden) is due to many reasons. Firstly, an active position not only and not so much supports the existence of those who have lost their jobs, but above all encourages the activity of every citizen aimed at finding a job, which, in turn, reduces its dependence on income support through social benefits ( and thus reduces costs. state budget), and also relieves tension in society associated with the difficult mental state of the unemployed (even if they receive fairly high benefits). Secondly, an active position increases labor productivity in general and, in particular, contributes to the structural restructuring of the economy, thereby increasing the efficiency of the use of labor resources, since its main task is to find the workplace for the employee as quickly as possible, where his return will be the highest. , that is, a workplace that will optimally match his mental and physical abilities.
Based on the foregoing, it is useful to review those activities active position employment in the labor market, which are used in foreign countries, as well as a brief analysis of the extent to which it is possible to apply similar measures in the Russian labor market. I would like to start the consideration with the most obvious, but at the same time one of the most effective measures to assist in finding employment, carried out by a specialized nationwide service. Its main task is to reduce the time for searching for vacancies, the unemployed and employees by entrepreneurs, as well as reducing the mismatch between workers and jobs. The Employment Service encourages employers to hire people who best suit their requirements, and employees find a place with better working conditions and/or higher wages.
In this way, main responsibility the employment office is to provide a meeting of buyers and sellers of labor. An entrepreneur with a vacancy can send an application to the agency, indicating the nature of the work, the required qualifications, and so on. Unemployed or a person who wants to change his workplace, has the right to ask about it at the bureau, for which he must fill out a registration sheet. Agency employees conduct an initial selection by matching requests and registration sheets. The employer is not obliged to hire the candidate found for him; the unemployed may also refuse a job offered to him. In almost all states, the activities of employment services are free of charge for both workers and entrepreneurs. The data collection and processing system is based on the same principles for the whole country, and the information is classified and not even available to the police.
The experience of France is interesting, where employment agencies organize special circles for the unemployed, holding classes 2-3 times a week on the topic “How to look for a job”, where various options for upcoming negotiations with employers are discussed, and other issues related to the rules of conduct when looking for a job. The activities of these circles are quite effective: they help 40 percent of their attendees find a good place for themselves. Despite the fact that the efficiency of the state employment service is high, only a small part of the vacancies is filled with its help, and these are mostly jobs that require low qualifications. For example, in Sweden only 35 percent job seekers contact the employment office. In France, 750 thousand people are employed through state agencies. per year, or 15 percent of the total labor requirement. Even in the US, which has 300 job banks spanning the entire country, only 5 percent of individuals get jobs through a recruitment service. The fact is that a number of reasons hinder the functioning of agencies. So, entrepreneurs with profitable vacancies, and good workers they rarely use their services, preferring to look for what they need through relatives and acquaintances or through advertisements and direct contacts. It is estimated that the majority of workers (56 percent) receive information about jobs from friends or family. Secondly, employers often do not announce their vacancies for fear of revealing trade secrets. In this regard, in some countries they are legally required to do so (the “Compulsory Registration of Vacancies Act” in Sweden). Thirdly, difficulties in evaluating both the proposed work and the workers not only reduce the success of the bureau's activities, but also reduce their prestige. In many cases, private employment agencies are more promising. Finally, the National Employment Service is often viewed as a job-seeking agency for the underdog, and employers perceive the people sent to them from the bureau as the worst part of the workforce. Another widely used government measure to improve labor market information is the publication of data on the future demand for various occupations, which is especially valuable for students choosing which career to prefer. However, these publications contain a lot of room for error: the figures given are national averages, while trends in local markets may vary; technological shifts that change the demand for labor are almost unpredictable; and many calculations do not take into account that this demand also depends on wages. As for the basic principles of the work of the Russian employment service, they are in line with international practice. Like employment offices in foreign countries, Russian authorities employment services ensure the publication of statistical data and information materials on the supply and demand for labor, employment opportunities. The activities carried out by our employment agencies are undoubtedly useful for many people who are out of work or seeking to find a new job. At the same time, to the difficulties experienced by the employment services of foreign countries, which the employment offices in Russia inevitably face, are added such difficulties specific to our country as the lack of reliable information systems including the necessary equipment, software, stable contacts with employers and workers. Under these conditions, it is necessary to significantly increase the scope of labor mediation through such means as, for example, multifunctional labor exchanges dealing with various professional groups workers from workers of broad specialties to workers intellectual labor; a variety of job fairs by territorial-industry, socio-professional, production-seasonal and other characteristics, depending on the situation in the labor market; specialized exchanges designed for specific categories of the population. At present, funds can also play a significant role mass media press, radio, television: we need special bulletins about vacancies, newspapers for those who are looking for a job, booklets that help them answer tests correctly, questionnaires that usually fill out during the employment procedure, and memos for those who are afraid of losing or have already lost its place containing the rules of conduct in the labor market. Vocational training and retraining programs, as recognized by many scholars, are the main direction of the active position of employment in the labor market, since employment prospects, especially in conditions of structural adjustment, are tightly linked to the development human resources: good education and qualifications reliably protect workers from unemployment. Thus, the share of those temporarily unemployed in the United States among those employed primarily in mental labor is 2-3 times lower than among manual workers, and among those with highest qualification the unemployment rate is 4-7 times less than the rest. A similar pattern can be seen in Eastern European countries: while unemployment was initially concentrated in skilled workers, now the highest levels of unemployment are among unskilled workers.
These programs are developed and adopted at the legislative level or implemented through joint participation the state and entrepreneurs in the organization of professional training and retraining of personnel. They are aimed primarily at people who have lost their jobs due to the fact that their former profession is outdated, those who can no longer work in their specialty due to illness, young people who have not received the necessary professional education, women -housewives who decide to return to the labor market. Usually candidates for training are looking for public service employment. She arranges studies and provides scholarships. Professional training may take place in special centers or as part of continuing education programs at the enterprise. In the centers, studies are structured in such a way as to provide people with a wide range of professions. Its high efficiency is guaranteed by the use individual plans taking into account the abilities and knowledge of each student, the modular principle of construction curricula and modern workshop equipment, including computers. For compiling training courses Leading specialists from universities are involved and industrial firms. The remuneration of teaching staff is carried out at the level that exists for employees of their class in the private sector. The total duration of training varies from a few weeks to 3 years, depending on the degree of complexity of the profession and the individual training and capabilities of the student. Such centers can be either public or private.
The labor market of medical workers: features of formation and regulationVlasova Regina Yurievna
Master's student in the direction of ESSTiN 1 g / o
Moscow State University named after M.V. Lomonosov,
Faculty of Economics, Moscow, Russia
Email:vlasreg @ya hoo . com
Russian healthcare labor market in the context of its accession to the WTO
Globalization is often perceived as a threat, as something that can be good for "others" and to which "we" have to adapt. At the same time, there are a number of compelling facts indicating that globalization is a unique opportunity for the whole world. However, Russia still has to adapt to it. This article summarizes the results of our study of the potential of "globalization" for one of the sectors of the Russian economy, namely health care, since it is the most important factor in shaping the health of the population, and therefore one of priority areas development of the country.
The study addressed a little-studied issue, namely possible changes in the labor market of the healthcare industry as a result of Russia's accession to the WTO, which is very relevant, since globalization (and the WTO is its leading institution) of the service sector will lead to significant changes in this industry.
Changes that may occur in the labor market of this industry, due to Russia's accession to the WTO, are , first of all, with private sector development. Based on the analysis of foreign experience, we can conclude that it is possible that competition will intensify in the market for expensive medical services that are no longer available to a wide range of citizens. At the same time, against the background of the expansion of the sphere of paid services, the quality of free services may decrease, including because many paid services are provided within the framework of state budget institutions. There is a risk that further development of the private sector in medicine will lead to higher costs health care and, as a consequence, to growth of the BSC(supply driven demand). Accession to the WTO in general can lead to a deeper "delimitation" of the health care system on the principle of commercial - non-commercial.
Problem partnerships in healthcare will "gain momentum". As the experience of foreign countries shows, additional part-time work in the private sector has begun to spread in the health care systems of those countries that have undergone a rapid liberalization of medical practice. An important feature of the private sector is that it pays more attention to issues of efficiency and resource management in general, and labor in particular, than state organizations do, in this sense, the emergence of a private sector in medicine will lead to more efficient use and management of medical staff.
Russian medical institutions and pharmaceutical companies(therapeutic, diagnostic, consultative, preventive medical services and pharmacology), after the WTO requirements are fully reflected in federal legislation, may face growing competition with foreign medical institutions in the domestic Russian market medical services. In order for domestic companies in the field of medicine to become competitive in the world market, and the healthcare sector to fulfill its primary function - protecting the health of the nation, large-scale investments and a consistent program for the development of healthcare are needed. The main object of concern should be the labor market. Only a clear policy of the state in this area of health care will help mitigate the possible negative consequences of joining the WTO and multiply the positive ones. At the same time, specifically assessing the impact of Russia's accession to the WTO on the labor market in healthcare, it is necessary to consider this issue from the point of view of the four WTO Agreements - GATS, TRIPS, TBT and SPS, which are based on the idea of liberalization and it is necessary to be prepared for its consequences.
The main positive opportunities for the development of the labor market in healthcare will be: the development of cross-border provision of medical services, the development of telemedicine, the development of the international market for medical educational services and etc.
Among the negative consequences, one can single out an increase in the “brain drain” of medical personnel. Due to the existence of the SSP, the employment situation in the regional health labor markets is likely to deteriorate. Since the employment of doctors depends on the average per capita GRP in the region, we can talk about the possible deepening of the regional differentiation of healthcare labor markets.
After Russia's accession to the WTO, healthcare will become one of the emerging industries service sector, enabling doctors to receive competitive salaries and choose a certain model of labor behavior.
The conclusion of the study notes that Russian society has every reason to be concerned about the impact that accession to the WTO will have on a country's ability to implement a national health policy in the interests of the population and, accordingly, its impact on the development of the labor market in this industry. This is also important because alternatives international systems trade and services formed within the framework of the WTO, yet. Therefore, it is very important to know well the "rules of the WTO game", the rights and obligations of the state, industry, medical personnel, and of course citizens, including an assessment of not only opportunities, but also risks. This implies an urgent need for information support for the process of integrating the healthcare system into this new format.
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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 the subject of hard exploitation, especially in today's economic and social reality. A sociological survey of those employed in the sphere of small businesses, conducted in Irkutsk, showed that the need for medical care is much higher than the number of people who apply to medical institutions. This is largely due to the influence of economic factors, and, in particular, the fear of changing the attitude 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 healthcare sector are related to the specifics of the product offered to the market, since this determines both the type of the medical services market and the characteristics of employment. 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 prolonged 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 human life”, which is contrary to tradition and culture (life is priceless).
If health is nevertheless considered as a commodity, then its place in the process of social reproduction can be determined, which will allow, in particular, to establish a certain level of remuneration for 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 the 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. Medium work week an American doctor 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 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 an extremely overregulated relationship between clients and medical workers, as well as various aspects of the latter's employment. 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 of healthcare, and state standards of 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 model of the health care market under consideration is characterized by a slow response to external changes affecting the health of the population and health services.
In conditions state regulation 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. The product in this market is understood to a greater extent as health, since the economic consequences of its violations are insured, but health is paid for 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, according to which the medical service is considered 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 professionals.
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 impossible for a patient to push back the consumption of medical care. The need for medical services is characteristic of any individual, regardless of the level of his income. 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 knowledge-intensiveness of services. For example, in Germany mobile phone in people with heart disease is connected to special apparatus, 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 some cases does not compensate for the costs of human labor, as is the case in the main industries. material production, but creates an increased demand for additional labor required to service new equipment. Equipping medical institutions with new equipment involves the involvement of various specialists - engineers, chemists, biologists, programmers, etc. In the area under consideration, labor remains 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.
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