A long-promised overhaul of medical pay in Russia is being pushed aside as the country’s compulsory health insurance fund prepares to use its reserves to cover a mounting deficit.
About 510 billion roubles accumulated for the reform may instead be spent on keeping the existing system running. The result is a familiar set of pressures for hospitals: sharp regional pay gaps, tens of thousands of vacancies and heavier workloads for the staff who remain.
Money set aside for reform fills an immediate hole
Russian media reported on 8 November 2026 that the government had effectively shelved a reform first prepared in 2021. It was intended to reduce the disparity between medical salaries in different regions and give public hospitals a better chance of recruiting and retaining staff.
Alexey Kurinny, a member of the State Duma, said the Federal Compulsory Medical Insurance Fund had accumulated roughly 510 billion roubles connected with the planned reform. The fund finances free medical care in Russia, but its projected spending is now expected to exceed its income. The reserves are therefore set to cover current costs rather than introduce a new pay system.
The pressure is expected to worsen in 2027. Transfers from the federal budget are projected to fall by almost 109 billion roubles, while the fund’s deficit is forecast at about 168 billion roubles. Closing that gap would mean drawing down the reserves that had been intended to support the wage reform.
This is not the formal repeal of a law. Its practical consequence is nonetheless substantial: the financial base for a reform delayed for years is being redirected to preserve the existing system. A measure designed to tackle a structural problem has lost out to an immediate budget shortfall.
The underlying imbalance is stark. Medical workers performing comparable jobs can earn three or four times as much in one Russian region as in another. At the same time, the country is short about 23,000 doctors and 63,000 workers in middle-level medical roles, including nurses and other clinical staff.
A shortage that feeds on itself
Vacancies do not simply leave posts empty. In hospitals operating below their planned staffing levels, longer shifts, larger patient lists and administrative demands fall on those who stay. Fatigue and burnout can then prompt further resignations, making the original shortage harder to correct.
Russia’s Health Ministry acknowledged a shortfall of 23,300 doctors and 63,600 middle-level medical workers at the beginning of 2025. The deficit was reportedly still close to that level by the middle of 2026.
Figures attributed to Russia’s state statistics agency, Rosstat, show the same imbalance in staff movements. During the second quarter of 2026, 185,300 employees left organisations in the health and social-services sector, while 165,900 people were hired. Departures exceeded arrivals by 19,400 workers, and 87% of those who left reportedly resigned voluntarily.
Those figures do not explain the reasons behind every individual departure. They do, however, point to a sector that is failing to replenish its workforce at the rate it loses staff. Pay is not the only factor influencing retention: equipment, management, workload and career prospects matter too. But a national pay reform was one of the few proposed measures capable of addressing regional inequality directly.
The consequences are likely to be most severe outside the major cities. Rural and remote hospitals generally have fewer specialists and less capacity to compensate for lower wages with better facilities or professional opportunities. If they cannot fill key posts, patients may have to wait longer, travel further or rely on overstretched teams.
When staff shortages become delays for patients
The staffing crisis matters most in areas where timing affects the outcome of treatment. Oncology is a clear example: delays in diagnosis or therapy can worsen a patient’s prognosis.
Data published in March 2026 by the organisation Movement Against Cancer indicated that only one in six surveyed cancer patients reached a doctor within the required timeframe. Only one in five said treatment had begun on time. Inspections by a specialised Health Ministry centre also identified an acute shortage of specialists, repeated breaches of diagnostic deadlines and failures to follow clinical recommendations.
These findings do not show that every delay was caused by the pay policy, nor that they describe every Russian hospital. They do illustrate how a staffing problem can become a direct access problem: an unfilled post can mean a missed appointment, a delayed test or treatment that starts later than intended.
That risk is magnified when experienced staff leave. Recruitment campaigns may bring new employees into the system, but they will struggle to stabilise hospitals if workloads remain excessive and pay remains uneven. Understaffing worsens working conditions; worsening conditions accelerate staff turnover.
Defence spending sets the limits
The fate of the pay reform is tied to wider federal spending decisions. Russia’s draft budget for 2027 allocates 17.1 trillion roubles to defence and 1.82 trillion roubles to health care. Compared with the initial plans for the same year, health funding is reduced by 6.8%, while defence spending rises by 27%.
The budget is still a draft and may change before final approval. The headline figures also do not necessarily capture every source of health funding. Even with those qualifications, the direction is clear: military expenditure is expanding as the health system has less room for salary increases, recruitment and improved working conditions.
Since Russia’s full-scale invasion of Ukraine, the government has directed a growing share of public resources towards military needs. That broader shift does not, by itself, establish the cause of every decision in the health system. It does explain the fiscal environment in which money reserved for reform is now needed to keep the insurance fund solvent.
Regional hospitals are consequently being asked to attract doctors and nurses without a consistent national pay structure, while their existing workforces are already under strain. In areas with few medical alternatives, the consequences can be felt in the availability and timeliness of care.
Compulsion takes the place of better conditions
Alongside the stalled pay reform, the authorities have introduced administrative measures intended to keep young medical professionals in the state system. Rules that took effect in March 2026 require graduates in certain medical specialties to complete up to three years of supervised practice. Students in publicly funded residency programmes must also sign targeted contracts, with financial penalties for breaking them.
Such measures may direct more graduates towards state hospitals in the short term. They do not provide higher pay, modern equipment, adequate staffing or more manageable workloads. A compulsory contract can postpone a departure, but it cannot remove the reasons an employee wants to leave.
The approach may also affect the system’s long-term appeal. If young doctors associate public medicine primarily with mandatory service and financial penalties, state hospitals could become less attractive to future students. Administrative pressure may delay attrition without preventing it.
Using the insurance fund’s reserves to cover its deficit therefore does more than postpone a pay rise. It removes one of the government’s main proposed tools for narrowing regional inequality and easing the staffing crisis. The unresolved question is no longer simply when the reform announced in 2021 will begin, but whether it can be financed while the health system needs its reserves to maintain ordinary operations.
The report on the funding decision is available in the published Telegram report.
