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Reference ID Created Released Classification Origin
07MOSCOW3540 2007-07-19 13:27 2011-08-30 01:44 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Moscow

DE RUEHMO #3540/01 2001327
R 191327Z JUL 07

E.O. 12958: N/A 
REF: Moscow 1811 
MOSCOW 00003540  001.2 OF 003 
1. (SBU) Summary: Although government doctors in Russia officially 
earn $205-$900 per month as a base salary, they frequently earn much 
more in reality.  Physicians often supplement their base government 
salaries for clinical work with income from private patients, 
teaching positions in universities and medical schools, and extra 
payments from insurers and local and regional governments.  Russian 
doctors are generally viewed as hard-working and enterprising, and 
they manage to make a decent living despite low official wages by 
wearing many hats and developing private practices.  There are also 
numerous reports of unofficial extra payments to give certain 
patients preferential treatment at public facilities, but our 
contacts disagree about whether to call these bribes or simply 
"gratuities."  End Summary. 
Public Health Care Salaries 
2. (U) With the launch of the National Priority Health Project in 
2006, the salaries of primary care medical professionals 
significantly improved, but official salaries are still low 
(reftel).  The monthly salary for primary care doctors and 
pediatricians working in the public sector is now $542-$890 per 
3. (SBU) With the National Priority Health Project raising base 
salaries in primary care, there has been a definite shift of some 
specialists and an influx of young doctors into primary care 
(reftel).  The head of a health NGO that works with health clinics 
in various regions of Russia told us this is at least partly 
explained by the greater salaries that primary care doctors can now 
receive compared to those who work in a more specialized area. 
According to the NGO's informal polling at public health clinics, a 
doctor working at the HIV/AIDS center in Saint Petersburg can expect 
to earn $271-$310 a month as a base salary, and a doctor in an 
HIV/AIDS center in Saratov earns $209 per month.  The infectious 
disease specialist in a public health care clinic in Saint 
Petersburg can earn $310-$349 per month; while, the same specialist 
in Saratov earns $122.  These salaries pale in comparison to a 
general practitioner in primary care practicing in Saint Petersburg, 
who can earn more than $969 per month at a public clinic; while a 
primary care physician in Saratov can earn more than $581 per month. 
4. (SBU) Medical salaries vary widely by region and are 
significantly lower outside of Moscow and St. Petersburg.  In 2005 
in the city of Angarsk, the average salary of all health care 
workers was $240 per month, and physicians earned about $360 per 
month.  In 2006, medical salaries in Angarsk increased to an overall 
average of $446 per month, while doctors' salaries increased to 
$760.  In Yakutia (Siberia), a doctor can expect to earn about $300 
a month. (NOTE: A good pair of winter boots in Yakutia can cost 
almost $400. END NOTE) 
5. (SBU) According to one consultant at a health NGO, an average 
physician in Moscow can expect to earn $200-$1000 per month in 
official income.  Primary care doctors in Moscow's public medical 
clinics make more, about $1,000-$1,350 per month.  However, given 
the high cost of living in Moscow today, many Moscow physicians must 
juggle multiple jobs to make a livable wage, and some resort to 
unofficial means to enhance their base salaries. 
Base Salaries Are Just the Tip of the Iceberg 
6. (SBU) The base salaries of doctors are enhanced in a number of 
ways.  Insurers and local and regional governments frequently 
provide payments to clinics and hospitals, which in turn are 
distributed to doctors in the form of monthly bonuses which 
supplement their base incomes.  Doctors also receive bonuses for 
outstanding service and for occupying more than one position within 
a given health care institution or at other clinics.  According to a 
senior Moscow cardiologist, the base salary only makes up about 18 
percent of a heart specialist's total compensation.  Payments from 
public and private insurers and from the Moscow city government make 
up about 64 percent of income.  An experienced cardiologist in his 
hospital makes about $791 per month in official salary, including 
extra payments from insurers and the government, while a department 
head makes about $1,542 per month.  The highest paid specialties in 
Russia are dentists, anesthesiologists, radiologists, intensive care 
doctors, and infectious disease specialists, according to the senior 
cardiologist.  (NOTE: Infectious disease specialists have always 
received higher pay to compensate for the extra risks associated 
MOSCOW 00003540  002.4 OF 003 
with their job.  An infectious disease physician's monthly salary at 
a clinic includes an additional 15 percent for the risks of treating &#x000
A;acutely infectious patients.  A doctor at an HIV/AIDS center 
receives an additional 60 percent for infection risks.  Even so, the 
number of infectious disease doctors is decreasing. END NOTE.) 
7. (SBU) On top of official salaries, doctors routinely maintain 
private practices at public facilities and schedule private clients 
in between their public patients in order to utilize state-owned 
equipment, though this practice is technically illegal.  Many 
specialists are able to cultivate an active clientele of patients 
who need long-term care or periodic monitoring of chronic 
conditions.  These patients will pay the doctor directly for 
consultations and visits, and will pay the hospital and clinic for 
tests, just as in the United States.  A doctor at a health NGO told 
us dentists, neurosurgeons, and obstetricians and gynecologists are 
among the highest-paid specialties and have plenty of opportunity to 
develop lucrative private practices on the side. 
8. (SBU) Russian doctors also sometimes receive monetary benefits 
from pharmaceutical companies for prescribing certain drugs, though 
these payments make up a fairly small share of doctors' overall 
income, according to our contacts.  One doctor told us that Indian 
drug companies are well-known for paying the most to doctors for 
prescribing certain drugs. 
9. (SBU) Many doctors find ways to supplement their salaries through 
entirely legal channels.  Many physicians maintain multiple 
positions within the health care sector.  For example, a doctor 
might work in a clinic during the day and teach night classes at a 
Private Health Care Salaries Much Higher 
10. (SBU) Private health care in Russia has become increasingly 
popular, especially in Moscow, because of rising incomes and a lack 
of patience with the public health care system.  A Moscow private 
diagnostic laboratory told us their physician salaries are in the 
range of $1,000-$2,000 per month.  A private Russian-Swiss company 
quoted salaries for medical advisors at $3,500 per month.  According 
to one contact, a Dentist at the European Medical Center in Moscow 
can expect to earn $3,000 per month, a general practitioner would 
earn $4,000-$5,000 per month, and a plastic surgeon would earn 
$5,000-$7,000 per month. 
Bribes, Tips, Cognac and Chocolates 
11. (SBU) Our contacts disagree about whether to characterize extra 
payments to doctors to receive better medical services through the 
state system as a bribe or simply as a "gratuity."  As one doctor 
contended, small gifts to doctors are traditional in the Russian 
culture.  Due to the close relationships which grow over time 
between doctors and patients, many patients feel it necessary to 
present their doctor with "gifts of gratitude," as one doctor told 
us, especially for obstetricians and gynecologists, dentists, and 
surgeons.  It is understood that by bringing gifts or making extra 
monetary payments, patients can expect better care in the future. 
As one doctor explained, "Someone willing to pay extra is a more 
attractive client." 
12. (SBU) According to one recent study conducted by the Russian 
branch of Transparency International, a patient can expect to pay an 
extra $90 a day in bribes or "tips" for medical care in Moscow. 
Contacts tell us that it is common to pay relatively small amounts 
of extra cash ($40-$100) both in clinics and in hospitals, but 
patients normally don't receive anything more than normal treatment 
and care in exchange for these unofficial payments. 
13. (U) According to a survey in June by the Levada polling center, 
the Ministry of Health and Social Development was considered by 19 
percent of respondents to be the most corrupt, the highest response 
rate of any Russian ministry.  (NOTE: The Ministry of Internal 
Affairs was the next highest with 15 percent of respondents 
considering it the most corrupt).  Of those surveyed, 51 percent 
acknowledged paying bribes for medical care.  Georgiy Satarov, the 
head of the anti-corruption NGO INDEM Foundation, claimed at a 
corruption conference in April that as many as 20 million Russians 
do not seek medical care, because they can no longer afford the 
routine extra payments needed to obtain medical services.  Problems 
with health care were also identified as one of the chief sources of 
complaints from citizens in the annual report released at the 
beginning of April by Vladimir Lukin, Russia's Human Rights 
MOSCOW 00003540  003.2 OF 003 
14. (SBU) Russia's doctors and nurses have long been underpaid based 
on their official salaries, and there is a long history of making 
informal extra payments to doctors.  One doctor told us a well-known 
anecdote about one of the Stalinist era Soviet Commissars, who said 
that doctors and teachers do not need a salary, "because the people 
will feed them."  During the Soviet era, a barter system of bribes 
was used in villages and medium-sized towns.  The butcher, for 
example, would ensure the doctor received the choicest cuts of meat, 
and the doctor would make sure the butcher and his family didn't 
have to wait in line when they went to the local clinic or hospital. 
 In larger cities, it was not uncommon for patients to bring a box 
of chocolates or bottle of cognac to the clinic as a gift for the 
doctor.  Today's Russia appears to be maintaining these traditions 
of privilege. 


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