Setting the Wages of Physicians and Nurses Employed 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. Financial incentives influence the health workforce’s job satisfaction and retention, while at the same time labour costs can account for the majority of total health expenditures, impacting the financial sustainability of health systems. The objective was to provide a structured overview of wage-setting processes for health professionals in 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, with the following steps: (1) a data collection form was developed based on the available literature and piloted; (2) purposive, snowball sampling was applied to identify national health policy experts who completed the data collection; and (3) a comparative analysis with two rounds of data validation was performed. Results: In all countries, the process of setting wages for health professionals employed in public hospitals is regulated separately from that of employees in the general economy. Dedicated regulations or agreements at the national level set a minimum or basic (fixed) wage levels for each health professional category. A relatively centralized wage-setting system is complemented by a decentralized hospital staff recruitment process. 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, in combination with the relatively common practice of dual employment, contribute to high system fragmentation and a lack of comprehensive data on actual wage levels. In all countries, formal minimum/basic wage levels have increased in recent years, and political decisions to raise wages were often preceded by strikes by medical workers. Conclusions: In CEE countries, health professionals’ wages are high on the political agenda. In recent years, wage increases have often been used as an ad hoc, crisis-driven policy to mitigate migration and improve retention. While wages are important, they do not guarantee health workforce stability. Financial incentives must be complemented by policies aimed at improving working conditions and career development opportunities.