R E P O R T referring to assess the costs related to health human resources

Designed by Oleg Galbur consultant assistance in developing local human resources strategy and action plan for implementation

Chisinau 2011

C O N T E N T S

Introduction …...... 3

Financial resources allocated to the health...... 4

Financial resources allocated to medical ...... 6

Financial resources allocated employees in the health system...... 10

Salaries of employees of different health system sectored...... 14

Financial resources payroll employees’ work in health system...... 20

Employee’s in the district Centers of Family Doctors………...... ……...... 25

Conclusions...... 30

2

Introduction

To the report in respect of expenditure relating to human resources in health include the results of analysis of various aspects of health system financing human resources chapter, such as resources allocated to the health system, health expenditure per capita, expenses, payroll, including comparison with other sectors of the economy depending on the GDP, the link between levels and the density of health workers. The report was prepared based on following sources: - Information submitted by the Budget and Finance Policy Directorate of the Ministry of Health - Financial reports and other relevant information available on the website of the Ministry of Health (www.ms.gov.md) - Information available site of the National Bureau of Statistics (www.statistica.md). - Information available on the website of the Ministry of Finance (www.mf.gov.md).

Along with assessments of financial aspects in the report are presented information regarding the number of employees in different sectors of the health system (primary care, emergency care, hospital care) or depending on the status of health care institutions (municipal, republican). Information on the payroll are presented including compared with other branches of national economy (education, transport, construction) but also in relation to average wage.

3

Financial resources allocated to the health system

Thus, analysis of the volume of financial allocations to the health system received during the last decade show that this indicator has suffered a significant and growing. According to data published by the National Bureau of Statistics, only in 2000-2005 financing of the health system increased from 471.9 million. up to 1572.4 million, which represents an increase of less than three. The same growth trend continued in coming years, reaching in 2009 the amount of 3846.9 million., representing an increase of over eight times compared with the year

2000 (Chart no. 1).

Chart. 1 Evolution of total expenditure for health care (million lei, NBS)

Therefore, taking into account that faces the bed, on 01 January 2009, resident population (people on evaluation / recording live permanently with permanent residence in that locality) of the Republic Moldova was 3565.604 thousand people, we can say that the health of every citizen that year were spent on average by about 1079 lei.

The share of health expenditure in the consolidated budget (total revenues and expenditures of state and local budgets, formed as independent elements in the budget) in the reference period ranged from a low of 11,3% in 2005 and 15,3% in 2002, settling in the dynamic growth continues a trend since 2005 (Chart no. 2).

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Chart. 2 Share of health spending in the consolidated budget and (NBS)

A dynamic upward clearly attests to the valuation of the share of health spending in gross domestic product (GDP), which is the main national accounting and macroeconomic aggregate is (the final result production activity of resident producer units and corresponding value of goods and services produced by these units for final consumption).

Thus, if health expenditures in 2000 constituted only about 2.9% of GDP, then by 2009 this indicator reached 6.4%, which is an increase of 100%.

In this context it is noteworthy that the continuous increase in financial allocations for the health system was conducted on background reduction in the period 2002-2009, the number of hospitals from 110 to 83, the absolute number of beds in hospitals from 24,443 to 21,938, but the degree of assurance to the population of 67.6 hospital beds / 10 000 inhabitants up from 61.6 / 10 thousand inhabitants.

At the same time, the reference period increased significantly the level of funding primary medical care sector and emergency medical care, these are considered as priorities in health system development.

5

Financial resources allocated to medical education

Another objective of the study in question was to assess the volume of financial resources for medical education and pharmaceutical organization, including different categories of funding and education (environment, education, postgraduate, continuous).

Thus, for organizing medical and pharmaceutical education in 2008 at the expense of state budget resources and special centers account funds have been spent in total amounting to 197307,9 thousand lei, and in 2009 this indicator amounted to 250497,9 thousand or about ¼ longer than the previous year (Chart no. 3).

Chart. 3 Financing of medical education in 2008-2010 (thousand lei)

At the same time, it is important to note that the total expenditure for higher education organization in the state budget were covered only about 60% annually, while the remaining about 40 % were covered from the special funds, from fees for basic studies in different types of contractual services, etc..

The data in question shows that medical education funding in the reference period was below the actual needs, is complemented with the account is considered as sources of special, enabling efficient organization and conduct of 6 medical education, but did not provide conditions for sustainable development and establishment strategic objectives and long term, providing considerable investment in this area.

Thus, in 2008 the state budget for higher education health care funds have been allocated in the amount of 54596,4 thousand lei, and for medical education programs have been allocated to 34684,2 thousand lei, and in 2009 for both education budget allocations were increased by about 20-25%, trends that have continued in 2010. But these increases were essentially focused on restoring the initial level of funding of medical education, given that in 2008, budget expenditures were reduced in all areas of economic and financial crisis.

The same trends were found and in finance education year postgraduate studies secondary residency and clinical studies, that funding has increased from 42222,5 thousand lei in 2008 to 53721,6 thousand lei in 2009. Much has been modestly funded continuing vocational training, which was allocated only 4636,7 thousand lei in 2008 and 5223,7 thousand lei in 2009, and the absolute level insufficient funding during the last decade has contributed to the degradation absolutely necessary for this form of training medical field of professional activity (Chart no. 4).

Chart. 4 Medical funding the state budget in 2008-2010 (lei)

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It is important to mentioned that during 2006-2008, the admission was made exclusively for specialty medicine with budget financing studies on contract basis shall remain in force only for specialties Dentistry and Pharmacy (total 150 seats) and therefore the expense of special fund has been significantly reduced.

Thus, only since 2008 has resumed coverage of expenses in an amount greater than the expense of special funds that have been 40,930,600 lei for medical education scared lei 12455,5 thousand for medical education environment.

For 2009 the volume of these funds in higher education increased by like 20% and the average medical school has decreased by approximately increased by about 10%, a reduction in demand for registration number fee. Specific financial ways volume for postgraduate education and, in particular that have continuously been so insignificant that they do not have influenced the forms of training (Chart no. 5).

Chart. 5 Financing medical education at the expense of special funds in 2008-2010 (thousand lei)

Therefore, the results of evaluations conducted in medical education financing chapter demonstrates that it was funded; in general, only the current needs.

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In recent years, about 40% of expenses were covered from the special funds, which work effectively confirm that medical educational institutions is directly dependent on the volume Financials funds from sources other than the budget, and these circumstances do not provide conditions conducive to sustainable development and environmental quality of higher and medium medical education.

In this context, it is important to maintain that education funding in Moldova volume is only a differentiated by categories of education (higher and specialized e), and within higher education are not differentiated approach depending on the complexity its various branches.

Regardless of education such as medicine, teaching, law, agriculture, engineering, etc.., financial policies are identical and the same principles apply in the allocation of financial resources, while medical education is much more complex in form and content that requires much higher investment compared to other areas.

Thus, the financing of medical education depends solely on the number of students and enrolled students annually to study and increase the number of people registered to study causes and increasing financial allocations for this form of education.

Conversely, the increase in funding medical education in certain years and not view a certain amount is only a direct consequence of increasing the number of people registered to study, purely quantitative principles that are applied in funding, given that until there present funding some quality principles, based on complexity and features specific term strategic approach, etc..

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Financial resources allocated to pay employees work in health care system

This indicator is directly characterizing the motivation, and satisfaction of each employee in the health sector is the average , which increased considerably during the reference period in absolute terms. In 2002 the salary of employees medical health system was only 439.1 lei, by about 37% lower than the average wage in the national economy, maintaining this difference virtually in till 2009. Although this indicator has increased considerably from year to year in 2009 recording an increase of over six times compared with 2002, however, always remained below the national average wage in the economy, reflecting the situation in Chapter fully pay doctors specialists who refer to one of those most qualified professionally (Chart no. 6).

Chart. 6 Evolution of average wages in the health and national economy

The average wage of employees in health care system in the reference period was lower than many other branches of national economy, which was a motivating factor for both for professionals already employed, but also for who were at the next election. Evaluating the attractiveness of the medical profession among young people, showed that most of them choose the medical profession of noble intent, romantic or follows the path of parents, doctors' remuneration and material security is not a strong argument in this case.

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The same situation persists in the mood of university students of medicine, which gradually realize that after graduation and in the labor force will have no material security, given the very modest salary that does not reflect the intellectual efforts, human and material investments, time medical studies (9-10 years), but other aspects.

Otherwise, payroll structure analysis of employees from various sectors of national economy in the period, showing that the amount employees pay expenses for the health system was much lower compared with the level indicator in other branches of national economy. Expenses for employee remuneration of health and social care ranged between 7% and 8.7% of all payroll expenditures in the national economy, always under the other sectors of the economy (Chart no. 7).

Chart. 7 Structure of remuneration of employees in various sectors of national economy (%)

The data presented in the chart shows that for the wages of health and social care have been used far fewer financial resources compared with other areas such as education, public administration or transport and communication, which places medical activity in the category of poorly paid, that is unattractive.

For example, the share of funds used to pay employees in transport and communications in the period 2003-2009 was about 35-40% higher annual compensation than the proportion spent on health system employees. 11

Unfavorable situation recorded in chapter pay health is confirmed by data on the evolution of the average monthly wage of employees in various sectors of the economy, and for comparison were selected following sectors: education, public administration, construction, transport and communications.

Thus, according to information published by the National Bureau of Statistics, the average monthly salary less than that of employees of health system employees have benefited only the education sphere, in other branches nominated the average salary of employees is significantly higher employee health, pay as much difference to 100% (Chart no. 5).

Chart. 5 Average monthly wage in various economic activities

For example, in 2003 the average monthly employee wages health (578.8 lei) was about two times lower than in construction (1194.0 lei) and government (1049.9 lei) and almost three times lower than in transport and communications (1453.5 lei).

In general, the same situation continued throughout the period 2003-2009 and later in 2010, which demonstrates that the medical services was not sufficiently attractive to graduates of medical school, but not sufficiently motivating for specialists with experience working in the system.

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As a result, the health system has faced massive movements of personnel in this period, but the refusal to engage young professionals in the pubic health care institutions, preferring less qualified even more activities and better paid.

An identical situation was also applied to compare the average monthly wage in the public and private health, although obviously in private activities in any branch of the economy are better paid. Statistics show that the average salary of employees in the private health sector was about one third higher than the average wage of employees in the public health system (Chart no. 6).

Chart. 6 average wage in the private and public health system (nominal gross ROL)

Thus, in 2005 the private health sector employees received an average monthly salary in the amount of 1457 lei, but public health workers have received Average monthly salary only about 1005 lei, in 2008 wages were respectively 3209 and 2240 lei lei, although there are grounds to suppose that in reality the monthly salary of employees in the private health sector was much higher.

Therefore, evaluations performed show that the health system employees, during the years 2003-2009, did not put any one of the categories of employees with an average remuneration of labor, given that their salaries were lower than most employees in other fields of national economy.

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Salaries of employees of different health system sectors

According to the reports of financial statistics for 2006 in the medical institutions providing curative and preventive services under the compulsory were a total of 11982 positions approved doctors being 10588 employed in total 8532 functions by individual physicians and doctors 1394 remained vacant positions in that year.

These shows that in 2006 nearly one third of the functions of approved doctors did not have coverage with individual physicians, that it was real shortage of doctors in the health system (Chart no. 7).

Chart. 7 Evolution of indicators on the provision of the public health doctors (2006-2010)

It is significant that the same situation continued in the coming years so that in 2010 recorded almost identically the same picture: a total of 12362 positions were approved doctors employed in total 10698, functions being occupied by 8633 doctors individuals that exceed the approved number of positions by about one third the number of individual doctors and half of the vacancies were filled by internal or external aggregation. The analysis of indicators evolution on work personally with secondary medical care (nurses, medical assistants, laboratory medical assistants, midwives) in the period 2006-2010 shows that in the case thereof with categories of specialists set trends were identical to those characteristic of doctors. 14

So in 2006 health care institutions that offer under compulsory health insurance have been approved for a total of 25070 medical staff functions with secondary education but were employed in total by only 22915 positions to 20,404 specialists secondary cares. And in this case half the vacancies of medical staff with secondary education were filled by internal or external aggregation, except in 2008, occupied by the overlapping functions when the report was insignificant. Therefore, in 2010 in public care institutions have remained unoccupied sanitary 1873 medical staff functions with secondary education, representing additional needs of the health system in this category of specialists (Chart no. 8).

Chart. 8 Evolution of indicators for nurses in the public health system (2006-2010)

The assessments of expenditures for wages of employees of medical institutions during the years 2006-2010, shows a gradual upward trend of this indicator to 41% at 46 %, although this rate was determined by normative documents provisions. In 2006, payroll employees were to use resources in a total volume of 739847,6 thousand lei, and in subsequent years such allowances were increased to the sum of 1651184,0 thousand or more than twice (Chart no . 9). Evolution of the average salary of employees in the compulsory health insurance, during the years 2006-2010, shows a significant increase by about 100% of the payroll of both doctors and medical staff with secondary education.

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In 2006, physicians received an average monthly salary of about 1820.79 lei and nurse an average monthly wage of 122,2 lei, which is about 1124.8 lei on average for both categories of professionals.

Chart. 9 The average ratio of spending on salaries in the public health care institutions (%)

Therefore, the average salary of doctors in 2006 was about 7% higher than the average monthly wage in the national economy, but the average salary of staff Medical high school was about 35% lower than average wage. Same trend was maintained over the coming years so that in 2010 monthly medical salary was about doctors 3981.36 lei, and medical personnel with secondary education of about 2553.43 lei, recorded more positive compared with the average wage (Chart no. 10).

Chart. 10 Evolution of the average wage in the mandatory health insurance (lei) 16

In this context, it is important to evaluate different medical institutions employees who provide medical services under the mandatory health insurance and health care with institutions funding from the state budget, taking into account the principles and mechanisms referred by financing.

Thus, in 2006 the average salary of doctors in medical institutions financed from the state budget was about 2030.44 lei exceeding some 200 doctors working in the salary level in public medical institutions, and the wage monthly medical staff with secondary education was about 1231.85 lei, or about 100 lei more than in public medical institutions.

Salary doctors in medical institutions was higher than budget wages average monthly savings by about 17%, and medical personnel with secondary education by about 28% lower than the . In the coming years to maintain the same pay medical report, which is in about 20,101 with 25% higher than the economy and pay the medical personal secondary education closer to the minimum wage, so that in 2010 the difference was only about 190 lei or about 6% (Chart no. 11).

Chart. 11 Evolution of average wages in the health care institutions with funding from the state budget

The significant results were obtained when assessing doctors' salaries in different sectors of the health system, especially primary health care (PHC) and

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Health Care Urgency (HCU). In 2006 the average salary of employees in the health system was about 1124.8 lei, and the doctors were at the level of 1820.79 lei, HPC – 2036,68 lei lei and AMU - 1897,79 lei. This order pay of various categories of employees remained until 2010, physicians and PHC sectors benefiting almost dries HCU in the years 2009-2010 the same wages, the difference being not important (60 lei). Thus, in 2010 the highest average monthly salary eligible GPs (4653.19 lei) and emergency doctors (4592.86 lei), much above the average salary of doctors in the health system (3981.36 lei ), but also above the national average salary (2950 lei). The reported, shows that during 2006-2010 the salary of family physicians increased by about 56% of emergency physicians increased by about 59% and the average salary of doctors in the health system increased by about 53%. But in reality those increases have not helped increase the satisfaction of physicians, thus reducing the purchasing capacity of national money (Chart no. 12).

Chart. 12 Evolution of the average salary of doctors in the public health system (lei)

The analysis of average salaries of medical personnel during the reference studies identified different both correlations between the different categories of payroll specialists with secondary education, and compared with the remuneration of physicians. In 2006 the monthly salary of medical personnel with backgrounds in environmental studies was about 1122 lei, almost at the average 18 wage level in the health system (1124.8 lei) and at a salary of PHC nurses (1122 lei). Only feldshers and assistants in the AMU in 2006 received a salary of 1354.02 lei, the highest compared with other sectors of the health system, and this salary gap was maintained over the next years to reach levels 3132,9 lei in 2010 (Chart 13).

Chart. 13 Evolution of the average salary of nurses in the public health system (lei)

If in 2006-2007 salary if all the specialists with secondary education, except for AMU, was at the same level since 2008 when it began a gradual differentiation, so that in 2010 the AMP nurses wage was about 10% higher than the average salary of these professionals in the system. In general, the average salary of media personnel in the health system during 2006-2010 increased, from 1122 to 2553.43 lei or approximately 56% of PHC nurses' salary increased from 1122 to 2748.7 lei or by about 60%, and nurses feldshers wage of AMU has increased from 1354 to 3132 lei or approximately 57%.

The data presented demonstrates that only the last four years the average salary of medical staff increased average by about 50%, in absolute terms can be interpreted as a significant increase, but the background reduction in purchasing power of currency national, this increase has not convincingly served as a motivational factor in the occupation by these specialists.

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Financial resources payroll work of employees from health system

In primary health care sector in 2006 were all approved in 3350 features the family doctor, during the year 2993 positions being occupied only by family physicians in 2610 individuals, ie 383 positions have been occupied by aggregation, and additional needs of the health system this year was about 357 family doctors.

It is significant that in the period 2006-2010 the number of family doctors in the public health system has declined from 2610 up to 2528 or 82 average family. Given that the number of GP functions approved annually ranged from 3336 to 2010 and 3427 in 2007, and the number of family physicians individuals decreased continuously in the consequence of the increased number of positions occupied by the family physician aggregation, shown by family doctors and by other categories of physicians (Chart no. 14).

Chart. Evolution 14 indicators of family physicians in PHC (2006-2010)

PHC sector is provided by nurses at a satisfactory level, which is due to the fact that young professionals working in rural areas, including district centers, benefit from certain incentives (financial benefits, including heat and electricity facilities connecting homes to natural gas pipelines, etc..), which has significantly increased the degree of acceptance of employment in rural areas by the graduates of the Colleges of Medicine.

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Thus, in 2006 approved a total of 8996 positions were nurse positions are occupied by 8342 individuals 772 nurses, which revealed that about 93% of positions were filled and only about 7% of the positions have remained vacant . In this respect, we can say with certainty that in 2006 the AMP of 10 nursing positions were filled in September and only one remained vacant, which is at the system level can be considered satisfactory.

Simultaneously, during the years 2006-2010, the number of nurses in PHC individuals decreased from 7722 to 7445 or by about 277 people, and this trend is likely to continue in coming years. Annual number of vacant nursing positions ranged from 641 in 2010 to 876 in 2008 (Chart no. 15).

Chart. 15 Evolution of nurses in PHC indicators (2006-2010) (lei)

The volume of funds for payroll employees of PHC in the reference period has increased considerably and, consequently, increased their average monthly salary is one of the largest health system in 2008 were used for this purpose 290213,0 thousand, which constitutes about 54% of total spending, and in 2009 expenses real wages of employees HPC increased to 348223,0 thousand lei, although the number of doctors and nurses has decreased slightly. This upward trend in the volume of funds for payroll employees in AMP was maintained in 2010, this indicator reached the level of 391197,8 thousand lei were about 53% of total costs, implying that an increase about 5 million. lei annual.

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Although the share of payroll is determined expenses normative provisions, however, increase primary healthcare funding and provide favorable conditions for raising wages in the sector of health employees. But these increases have not helped to increase the attractiveness and motivate young professionals to work in this sector and therefore the number of family doctors is steadily declining (Chart no. 16).

Chart nr. 16. Volume 16 expenditures for salaries of employees of AMP (%, lei)

The tendencies financing trends outlined in the relevant district clinics since 2008 when it was legal delimitation of the primary health care system of hospital and statistics to finance by the year refers 2007 include all sectors of the health system (primary care, hospital care and specializes in outpatient care).

Thus, in 2008, district hospitals have received in total funds in the amount of 616957,0 thousand, or about 80 million. lei more regional centers of family physicians. Just over 2009 available moneys to district hospital services increased by about 10 million lei, reaching the level of 719320,2 thousand lei, which represents an increase of about 15% over the previous year.

Hospital district employees for wages in 2008 were used 276103,5 thousand lei, which is about 45% of total expenditure, while in 2009 the volume of funds used to pay employees increased to 335786,4 thousand lei or about 18% the previous year. In 2010 also remained volume growth trends financial means pay for district hospital staff, although to a lesser extent, but these increases have 22 not had a significant impact on employee satisfaction, motivation and growth (Chart no. 17)

Chart. 17 Volume expenditures for salaries of employees in the District hospitals (%)

Municipal public medical institutions have received funds in 2006 amounted to 382507,9 thousand lei and for wages to employees have been used 152645,9 thousand lei, or about 40%. Over the next few years the level of funding public medical institutions of the cup municipal considerably, so that every year this indicator has increased by about 10 million lei, while in 2010 it almost doubled compared with 2006 and amounted to 763 651,9 thousand lei.

Concomitantly, significantly increased the volume of funds for employee payroll from 152645,9 thousand lei in 2006 to 344995,2 thousand lei in 2010, which represents an increase of about 55% and the proportion spent on pay total expenditures increased during the reference period from 40% to 45%, which was reflected on the employee's average monthly wage. The Republican health care institutions expenditure ratio of total payroll costs were the lowest compared with other institutions.

For example, in 2006, the volume of payroll funds for employees of medical institutions were Republican public sanitary only about 37% and in absolute figures were 253 225,1 thousand lei (Chart no. 18).

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Chart. 18 Volume expenditures for salaries of employees in municipal institutions (%)

In 2006-2010 financing of the Republican health care institutions increased from 688,990,800 to 1371668,7 thousand lei , which is an increase by about 100% The volume of funds for payroll employees increased from 253225,1 thousand lei in 2006 to 559878,2 thousand lei in 2010, which represents an increase of 100% (Chart no. 19).

Chart. 19 Volume expenditures for salaries of employees in the republican institutions (%)

Data from current assessments show that in recent years the funds earmarked for salaries of employees has increased continuously in all sectors of the healthcare system that has increased the average monthly medical nurses wage. But wage increases have not registered to become an attractive factor for health system employees, such as inadequate remuneration of labor remains one of the basic factors that disincentive to work.

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Salaries of employees in the district Centers of Family Doctors wage employees

Analysis Centers Family Physicians district shows that, generally, physicians receive a monthly salary almost twice higher than average salaries by institution and nurses receive salaries the halls mean level institution. But significant differences are recorded in both categories of professionals from wages and salaries at a function at a busy person, which also shows that wage increases usually are caused by overlapping functions and not the real increase in wages or alto implementation mechanisms reasoning.

Another conclusion is that as the district public health care facilities are better provided by doctors and nurses, the salary is less than one and vice versa in districts with shortages of health professionals is much higher salary, due to employment functions cumulating vacancies.

Thus, in 2008 the highest wages in an occupation according to the doctor were recorded in the districts Floresti (4766.67 lei) Sangerei (4505.07 lei), Stefan Voda (4371.35 lei) and Falesti (4356, 25 lei), and the density of doctors in these districts is entirely different, which also does not allow to find issues and principles identical in the pay process (Chart no. 20).

Chart. 20 The average wage in a position occupied in 2008

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While the lowest wages in a busy office were recorded in the districts Soroca (2357.33 lei), Şoldăneşti (2933.89 lei) and Comrat (3004.15 lei ) where the density of doctors is at a satisfactory level. The highest salaries for nurses function were in Dubasari înregstrat (2425,06 lei), Hincesti (2341,47 lei), Cimislia (2216.35 lei), Floresti (2216,27 lei) and Falesti (2199,32 lei), but in this case the density of nurses was very different, for example, is satisfactory in Floreşti and Hincesti extremely serious. The situation changes if the average monthly wage assessment to a person, which is the sum of all revenues for basic office work and part-time work or other forms of the profession. In 2008, average salaries of doctors from an individual were highest in districts Cantemir (6301.52 lei), Leova (6197.35 lei), Falesti (5961.18 lei) and Sangerei (5924.17 lei) districts faced severe difficulties in ensuring doctors and nursing personnel (Chart no. 21).

Chart. 21 The average wage to an individual in 2008

Much lower wages to an individual in 2008 were recorded Soldanesti (3160.91 lei), Donduseni (3264.68 lei), Briceni (3459.06 lei) and Soroca (3485.48 million), districts that usually are provided with enough doctors, most of activating only a salary and, therefore, labor remunerated districts is below average.

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The highest salary a function of the nurses get busy Hincesti (3138.06 lei), and actually pay the doctors in the district Şoldăneşti, and this is only because a considerable number of nursing vacancies are filled by the aggregation .

Just over a year painting in employee pay and health care institutions to substantially amend the district, evidence of instability and principles used in the remuneration policy to work, but also a lack of strategic objectives over the medium term at least this chapter.

Thus, the average salary of a doctor in a busy office in 2009, was higher in districts Cantemir (5082.38 lei), Falesti (5010.19 lei), Drochia (4960.43 lei) and Glodeni (4856, 96 lei), and the function of nurse employment was higher in raionele Floresti (2823.95 lei), Hincesti (2786.01 lei), Dubasari (2749.12 lei), Cahul (2677.39 lei) (Chart no. 22).

Chart. 22 The average wage at a function held in the extremely low wages in 2009

According to a doctors’ employed in 2009 were recorded Ocnita (3389.76 lei), Soroca (3520.42 lei) and Ceadâr-Lunga (3588.75 lei) and the lowest salaries of the nurses office received Ocnita (2030.56 lei), Leova (2083.23 lei) Taraclia (2152.68 lei) and Vulcanesti (2178.59 lei) .

The average salary to an individual employee in 2009 to district health institutions increased considerably in most districts, although in some districts has

27 remained virtually the same level as the previous year if doctors and nurses, or if average per institution. Thus, in the year of the highest salaries to individual doctors benefited districts Cantemir (7411.81 lei), Falesti (6937.18 lei), Cimislia (6717.01 lei), Nisporeni (6458.33 lei) Sangerei (6383.84 lei) and Hincesti (6327.46 lei), and the most modest salary to an individual doctors benefited districts Donduseni (4063.75 lei), Ocnita (4016.12 lei), Briceni (4205, 68 lei) and Soldanesti (4199.58 lei), primary healthcare districts is provided fully by family doctors (Chart no. 23).

Chart. 23 The average wage to an individual in 2009

An identical situation where individuals pay a medical secondary education, being recorded the highest salaries in the districts Hincesti (3761.85 lei), Ialoveni (3157.53 lei) , Falesti (3004.33 lei), Soroca (2964.99 lei), Cimislia (2935.83 lei) and Basarabeasca (2948.54 lei).

At the same, into a multi series of regional public medical institutions, even to an individual salaries for nurses are extremely modest, such as districts Donduseni (1918.37 lei), Ocnita (1979.79 lei) Edinet (2012.05 lei) Briceni (2040.51 lei), and Drochia (2044.8 lei), in fact, all in the north, where the intensity of nursing is quite favorable.

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In order to identify some correlations between the density of family physicians and their salaries at the district level were superimposed diagrams representing these separate indicators on districts (Charts 24-25).

Chart 24-25. Correlation between density and pay 24 to 25 family doctors in 2009

The analysis of these two charts outlining concurrent one type of correlation between these two parameters: the density of family physicians is inversely proportional to salary levels, which is otherwise opposed an logical correlation between these two indicators directly proportional. Therefore, the district Centers of Family Physicians, the salary increase was caused only by the aggregation of vacancies, which contradicts the principles of quality assurance work. Those mentioned, indicates that the regional public health institutions providing primary health care mechanisms are not real financial motivation of employees, that contributes to ensuring medium and long term population and health professionals needed, namely, public access quality health services

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Conclusions:

1. Medical Education in the last decade has been financed, in general, only the current needs, and about 40% of expenses were covered from the special funds, evidence that medical education is directly dependent on the volume of funds from other sources Financials than budget, which does not provide favorable conditions for sustainable development of quality medical education.

2. Financing of education in Moldova is only a differentiated by categories of education (higher, secondary specialized, professional), and within higher education are not differentiated approach depending on the complexity of its various branches. Regardless of education (medical, educational, legal, agriculture, etc..), The same principles in allocating financial resources, while medical education is much more complex in form and content that requires much greater investment than other areas.

3. The amount of financing medical education depends solely on the number of students and enrolled students annually to study and increase the number of people registered to study causes and increasing financial allocations for this form of education. Conversely, the increase in funding medical education in certain years and in a certain volume is a direct consequence of the increasing number of people registered to study, given that present are applied only to purely quantitative principles in funding medical education.

4. Of all forms of medical education in the last decade, the worst section was funded of doctors and health workers with secondary education, which consequently led to degradation of this form is absolutely necessary for the effective training of a specialist medical studies and

30 rehabilitation of this form of medical training will require concerted efforts and considerable financial

5.The average salary of employees in the health system in the reference period was below the average salary of employees of many other branches of national economy, being a denominating factor for both doctors work, medical students and residents and for those who were at stage choosing future profession, given that wage levels do not reflect the efforts of intellectual, human and material investment, the duration of medical studies (9-10 years), but other aspects of process-specific training and of doctors.

6. In last five years pay family doctors has increased by about 56% of emergency physicians increased by about 59% and the average salary of doctors in the health system increased by about 53, but those increases have not really contributed to increase satisfaction of physicians and work in the public health system has become more attractive, doctors still remains a poorly paid group of employees.

7. The pay level of family doctors is inversely proportional to their density, thus increasing the wage was only determined by the aggregation of vacancies, evidence of lack of effective mechanisms of financial motivation of employees, to help medium and long term providing the population with the necessary professionals, respectively, to ensure people's access to quality health care

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