Setting the wages of physicians and nurses working in hospitals across ten central and Eastern European countries - A comparative analysis.

BACKGROUND: The process of setting wages for health professionals plays an important role in shaping health system performance by influencing both workforce satisfaction and providers' financial sustainability. OBJECTIVE: The objective was to provide a structured comparison of wage-setting processes for health professionals across ten Central and Eastern European (CEE) countries, with a particular focus on physicians and nurses employed in public hospitals. METHODS: A cross-country comparative analysis was conducted: (1) a data collection form was developed and piloted; (2) purposive, snowball sampling was applied to identify national experts who completed the data collection; (3) a comparative analysis was performed. RESULTS: In all countries, dedicated regulations or collaborative agreements at the national level set either a minimum (which providers are free to exceed) or a basic (fixed across providers) wage level for each category of health professional. This centralized wage-setting system is complemented by decentralized recruitment of hospital staff. While standard employment contracts are usually the dominant form of employment, other types of service or business-to-business contracts are also used. These may apply to both internal and external hospital staff and, together with the relatively common practice of dual employment, contribute to substantial system fragmentation and disparities in actual wage levels. CONCLUSIONS: In CEE countries, health professionals' wages remain high on the political agenda. In recent years, wage increases have often been used as an ad hoc, crisis-driven response to mitigate migration and improve retention. Financial incentives must be complemented by policies aimed at improving working conditions and career development opportunities.