The All-Russian Union of Patients (VSP) has urged the government to broaden incentive payments for healthcare workers who operate under the compulsory medical insurance (CHI) system in non-state clinics. This request was reported by Vedomosti and is based on a letter from the union’s co-chairs, Yuri Zhulev and Yan Vlasov, sent to Prime Minister Mikhail Mishustin on September 20. Questions directed to the government were referred to the Ministry of Health by a government press service representative.
The letter clarifies that medical care under CHI in Russia is delivered through both public and private hospitals. It also notes that more than 4 million people receive CHI services in facilities outside the state system. Despite this broad delivery network, incentive payments from the state are currently issued only to staff working in public and municipal clinics and dispensaries that participate in CHI programs.
VSP argues that the state’s policy of financing rewards to employees in public hospitals was intended to reduce staff shortages and attract physicians from commercial clinics. While this approach helps fill gaps in some regions, it appears to create new gaps in others, leaving the core issue unresolved in multiple areas of the country.
The union emphasizes that private clinics’ doctors do not receive government payments because their institutions operate under different ownership models. As a consequence, many physicians are attracted to public clinics where incentive pay is available, narrowing the talent pool for private providers and potentially affecting the overall patient landscape.
There are reports that healthcare workers who previously lived in various Russian regions have started to reduce their clinical fees, which could reflect broader shifts in compensation expectations and employment conditions across the CHI framework. This evolving dynamic raises questions about how to balance incentives across state and non-state sectors while preserving access and quality for patients enrolled in compulsory health insurance. In the near term, stakeholders from patient organizations, medical unions, and health policy circles are likely to seek a more unified approach that aligns payments with service delivery, regional needs, and the sustained availability of capable staff across all facility types.
Experts suggest that any reform should address not only the level of payments but also the distribution mechanism, ensuring that clinicians in private clinics are not disadvantaged and that incentives do not distort patient choice or the competitive landscape. A transparent, nationwide framework could help harmonize pay structures without eroding the existing CHI coverage and patient access. Overall, the discussion highlights the ongoing tension between financing models, workforce distribution, and the quality of care in Russia’s hybrid health system, a topic that continues to attract attention from policymakers, medical professionals, and patient advocacy groups alike. In terms of practical steps, observers recommend a phased approach, prioritizing regions with acute staffing shortages while piloting private-sector incentive schemes to gauge impact on retention, patient outcomes, and service availability, all while maintaining compliance with CHI rules and protections for public health funding.