Kaupo Koppel, an expert at the Foresight Center who worked on the report, said that over the past 10 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.

He stressed 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 percent of Estonian healthcare workers hold down multiple jobs.

Up to 33 percent of doctors work 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 €700–1,100 less than that in the public sector. At the same time, nurses and midwives employed in the private sector had a €130–420 lower gross income.

The difference is caused by the fact that the share of bonuses is up to 26 percent of the basic salary in the private sector, but up to 46 percent 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.

Trend not seen in Nordics

The "Healthcare Workers' Movement between Private and Public Sectors" report also looked a the wider region. It shows that the Baltic countries and Poland's healthcare workers are moving from the public sector to the private sector. The trend is not observed in the Nordic countries.

In Estonia's neighbouring countries, the proportion of private sector healthcare workers has grown fastest in Latvia, where up to 30 percent of workers are in the private sector, Lithuania (40 percent) and Poland (45 percent) 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 percent of healthcare workers are employed in the public sector. This is due to high salaries, but strong trade unions and collective agreements are important as well. The private sector provides primarily a narrower specialisation to its employees.

The Foresight Center is a think tank at the Riigikogu that analyzes socio-economic trends and builds future scenarios. The Centre researches a range of topics in order to anticipate emerging trends and potential disruptions.

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