Setting the Wages of Physicians and Nurses Employed in Hospitals Across Ten Central and Eastern European Countries – A Comparative Analysis

Setting the Wages of Physicians and Nurses Employed in Hospitals Across Ten Central and Eastern European Countries – A Comparative Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Setting the Wages of Physicians and Nurses Employed in Hospitals Across Ten Central and Eastern European Countries – A Comparative Analysis Katarzyna Dubas-Jakóbczyk, Antoniya Dimova, Triin Habicht, Mircha Poldrugovac, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8624946/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract 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. wage salary physician nurse hospital Central and Eastern Europe Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 May, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor assigned by journal 19 Jan, 2026 Submission checks completed at journal 19 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8624946","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602990611,"identity":"8288641f-02f8-4b75-971a-e485eac6bcf6","order_by":0,"name":"Katarzyna 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Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO 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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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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, \u0026nbsp;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Setting the Wages of Physicians and Nurses Employed in Hospitals Across Ten Central and Eastern European Countries – A Comparative Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 07:11:51","doi":"10.21203/rs.3.rs-8624946/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"124026392934259695151838083101622675969","date":"2026-05-05T07:54:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T22:18:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326884789220833915205355685076466121795","date":"2026-03-25T19:57:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121936028492892830287087538902037232938","date":"2026-03-08T16:55:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T16:42:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T06:46:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T06:45:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Human Resources for Health","date":"2026-01-17T09:22:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c64ca803-5a4f-4f36-80e7-809ea03d5d34","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"124026392934259695151838083101622675969","date":"2026-05-05T07:54:49+00:00","index":53,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T07:11:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 07:11:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8624946","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8624946","identity":"rs-8624946","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}