Report: Healthcare workers are leaving the public sector despite higher wages

Kaupo Koppel, an expert at the Foresight Centre, revealed that over the past ten years, an increasing number of healthcare workers have left the public system for the private sector. “Higher salaries in the private sector are not the reason for this, as today, the total wages paid in the public sector are higher in almost all positions, but unfortunately this is due to overtime work and other bonuses,” said Koppel, stressing that a system based on working overtime is not sustainable in the long run, primarily when it comes to healthcare workers’ satisfaction and their retention in the public sector.

Today, 14% of Estonian healthcare workers hold down multiple jobs. Doctors do so the most, with as many as 33% of them working in several positions. One of the doctors’ multiple jobs is usually in the public sector.

Over the past five years, the average monthly gross income of doctors working in private clinics has been 700–1100 euros less than that in the public sector. At the same time, nurses and midwives employed in the private sector had 130–420 euros lower gross income. The difference is caused by the fact that the share of bonuses is up to 26% of the basic salary in the private sector, but up to 46% of the basic salary in the public sector, and the share of bonuses in the public sector has kept increasing over the past five years. A possible reason for this is the increasing amount of overtime work.

The Foresight Centre shows in its short report that in the Baltic countries and Poland, healthcare workers are moving from the public sector to the private sector, while the Nordic countries are maintaining the current balance.

In Estonia’s neighbouring countries, the proportion of private sector healthcare workers has grown fastest in Latvia (up to 30% of workers are in the private sector), Lithuania (40%) and Poland (45%) in recent years. In Latvia, Lithuania and Poland, low salaries and poorer working conditions resulting from an underfinanced healthcare sector are factors driving healthcare workers to move to the private sector.

“Long wait times, causing patients to seek out faster treatment, as well as better equipment and more flexible working conditions in private clinics are definitely having an impact, too,” said Koppel. “This has led to a situation where a significant proportion of doctors and nurses work fully or partially in private healthcare, especially concerning primary care and outpatient services.”

However, in Finland and Sweden, 75-78% of healthcare workers are employed in the public sector. The retention of the workforce in the public sector is ensured by high salaries, but strong trade unions and collective agreements are important as well. The private sector provides primarily narrower specialisation to its employees.

The short report “Healthcare Workers’ Movement between Private and Public Sectors” (in Estonian) is part of the Foresight Centre’s research stream “Healthcare Sustainability”. The purpose of the research stream is to find future opportunities and analyse alternative options to diversify healthcare funding and their impact on the accessibility of healthcare services in Estonia up to 2050.