This system employs the United Tariff Rate to pay employees allowing little flexibility in salaries across staff or across institutions. In 2008, the government introduced a reform of wages and salaries setting in the public sector. The new approach allows greater flexibility to hospital managers, who will be able to decide on the number of employees and their remuneration level under a pre-determined budget envelope. Although the Russian Federation has had a long tradition in this area, inadequate attention has been given to chronic diseases, which now makes up the bulk of morbidity both in the Russian Federation and elsewhere.