'Black Swan' Tax Change Drives Up Medical Service Prices

On 29 December, private clinics found an unwelcome gift under the Christmas tree — the state recognized their business as lacking social importance. Consequently, the cost of medical services has increased by 15–30% since the new year. Seeing this, insurers realized that voluntary health insurance (VHI) contracts signed with organizations for employees would result in significant losses. Fontanka found out how service costs in non-state clinics will rise and what the consequences are.

«There is not a single supplier that hasn»t raised prices since 1 January by less than 10%, and mostly by 15 to 35%. Even the main recruitment platform for medical professionals, HeadHunter, has increased its rates. Replacing broken equipment that can«t be repaired is difficult — but working without, for example, an ultrasound machine is impossible, so last year we had to take out a loan at 25% annual interest. We expected, of course, that there would be an increase, and calculated the new cost of services based on real expenses, not on officially announced statistics. And on 29 December, we learned that the medical business had been struck from the register of socially significant businesses — payroll taxes increased. Now prices are being recalculated again, and as a result, the cost of medical services at different clinics has risen at the beginning of the year with a range from 0 to 30%.»

Why Medical Service Prices Jumped

Everything is getting more expensive, and medicine is no exception. But, as market participants told Fontanka, it«s not inflation or the 22% VAT that became the main trigger for such a price jump at the start of the year. From the factors predicted last year, some have appeared unexpectedly. Why the average bill increased by a quarter is explained by Alexander Solonin, General Director of the Association of Private Clinics.

«On one hand, medical organizations are exempt from VAT, and it would seem that its increase doesn»t affect them. The problem is that clinics purchase goods and services that include the new VAT. For example: a clinic needs a sterilizer for a million rubles (approximately $10,000 at current rates) plus VAT — with 20% it was 1.2 million rubles (about $12,000). With the new VAT — 1.22 million rubles (about $12,200). There are clinics with high procurement costs — if they reach 100 million rubles (about $1 million) per year, now that«s an extra 2 million rubles (about $20,000). For the medical business, that»s a significant amount.

Secondly, small clinics with incomes up to 60 million rubles (about $600,000) per year used the simplified taxation system (STS). From 2026, the income threshold is lowered — to 20 million rubles (about $200,000) per year. According to experts« estimates, their expenses increase by 5–7%.

And third, the main thing that affected the rise in medical service costs is the increase in insurance premiums for small and medium-sized enterprises (SMEs): the cancellation of benefits on insurance premiums (payroll tax contributions). Recall that small businesses include clinics with annual revenue up to 400 million rubles (about $4 million) per year, medium-sized — up to a billion (about $10 million). That is, the majority of the medical business. Those with revenue over 60 million rubles (about $600,000) worked without STS and typically paid white wages.«

During the pandemic, all SMEs received benefits on insurance premiums as socially significant businesses — 15% on payments exceeding 1.5 times the minimum wage per month.

Example: a surgeon«s salary is 200,000 rubles (about $2,000), from which 13% personal income tax is withheld. In 2025, the organization had to pay an insurance fund contribution for him of 30% on 1.5 times the minimum wage (from 33,660 rubles, that»s 10,098 rubles, or about $101) and plus 15% on the remaining amount — 24,951 rubles (about $250). That totaled 35,049 rubles (about $350).

From 2026, it must, like everyone else, pay a «social tax» on the entire salary at 30%. That is, the employer will pay a payroll tax for this employee of 60,000 rubles (about $600) — almost double.

«We estimated payroll tax contributions for our medium-sized business with a maximum revenue of one billion rubles (about $10 million) per year. In 2025, its payroll fund averaged 500 million rubles (about $5 million) — half of revenue. Suppose the company has 200 employees with different salaries, the overpayment — more precisely, the change in social contribution size for one month will be over 5 million rubles (about $50,000) — 60 million rubles (about $600,000) per year. That»s approximately 7% in real costs for clinics,« explained Solonin.

Representatives of the medical business say that the cost increase far exceeds the official inflation level reported by Rosstat. The rise in tariffs from monopolies for electricity, communications, utilities, the cost of services and goods, plus inflationary expectations, the industry factors into pricing. As well as the fact that due to high key rates, there«s no way to compensate for costs: loans are scarcely available for business development.

As Alexander Solonin says, for 2026 it was forecast that the average bill for a patient in a private clinic would increase by at least 10%. But on 29 December, it became clear that this was an optimistic scenario. Today«s forecast is a 15–20% increase on average. However, in the clinics themselves, Fontanka was told 25% and 30%. Some of them plan to gradually include costs in patient payments to avoid a January spike. Others have already included them in prices from the start of the year.

«We»re Still Considering«

Anna Sokolova, director of the «21st Century Medical Center», said: «We, like all private clinics, entered the New Year realizing the challenge we face, and we»re still considering. Usually, our company raises prices in mid-summer — even then it was roughly clear what awaited us. We thought that, as usual, we had reserved for the first half of 2026 so that neither VAT nor inflation would affect our work. Like everyone, we were confident that we would remain in prioritized business areas.

The increase in payroll taxes from 15 to 30% is critical for us, but it«s not a reason to immediately, say from 1 January or 1 February, raise prices. We understand that for our target audience — patients, it»s hard to bear an additional conditional 10%. Moreover, we cooperate with insurance companies, whose policy prices were set earlier.«

According to Sokolova, the company will watch the market reaction and the impact of tax increases: «We will assess the dynamics of cost changes, and then decide — whether we can hold out until mid-summer to raise prices in our traditional timeframe or if we need to take action earlier.»

«People Are Scraping Together Money for Teeth with Great Difficulty»

There is good news: the predicted 100% increase in dental services at the end of last year won«t happen. Moreover, even a market-wide price hike of a quarter is unlikely.

«Dentistry won»t get that much more expensive for anything — there«s no room. People are already scraping together money for teeth with great difficulty as it is. For example, we haven»t had major operations or prosthetics since the New Year, people are saving,« says Emil Agadzhanyan, General Director of the »Medical Center of Kind Dentists«. »I think the cost increase in our industry will be gradual, bit by bit. It«s an old service in an old market, and we shouldn»t make sudden moves. Competition is high, there are almost two dental clinics in every house now. Whoever raises prices will lose competitiveness. Therefore, most will likely endure losses but won«t be able to jack up prices — only within inflation.»

It«s clear that the most material-intensive areas will suffer the most — implantology, orthopedics, orthodontics. But as Agadzhanyan says, dentistry has long learned to pay for itself. Everything needed is supplied through new schemes and routes. Moreover, these schemes often cost less than the previous official ones, thanks to which dentists still work with quality materials. Although expensive imported implants have already gone up by 8.5%, and not only that: all suppliers have slowly started issuing new price lists.

«Narrow- or multi-profile clinics raise prices because they don»t have the same competition as dental clinics. Our market is so oversaturated that for the first time in its history, clinics are closing even without increased payroll tax contributions. And with this option, there«s a suspicion that business will start returning to the gray zone — when it becomes unbearable, they»ll start paying cash in envelopes again. But you can«t sit in the gray zone for long because everything is quickly figured out. It will end badly,» says Agadzhanyan.

«You can»t sit« because specialized groups under interdepartmental commissions in St. Petersburg districts are monitoring illegal employment. Specialists regularly request the number of employees in a company. For example, in the Moscow District, they require that the salary be at least 90,000 rubles (about $900) per average headcount, Fontanka was told by one clinic. If you show a lower salary — you»ll be suspected of tax evasion and called on the carpet.

Policy at Old Prices, Medical Services at New

How will voluntary health insurance (VHI) live with all this? Insurers signed contracts with clients based on the forecasted 10% average increase in medical service prices for 2026. And they themselves raised the cost of their policies by 8–10%. There is a suspicion that the insured will face total administration of every clinic visit, where one and a half examinations are allowed, but three — not.

Alexey Kuznetsov, General Director of the company «Kapital-polis» predicts: «It will be very bad.» Because the cost of medical services has grown even without accounting for the «black swan» that arrived right before the New Year, and now some clinics have issued downright sky-high price lists.

«Insurers always increased policy costs less than medical professionals, otherwise clients wouldn»t understand us. As a result, for our companies working in the VHI system, the cost of packages for their partners in 2025 was based on one set of prices, and from the first days of 2026 we saw another,« says Kuznetsov. According to him, a comparative analysis of prices in January 2026 versus January 2025 for medical services in centers that »Kapital-polis« works with showed: on average, the increase across the general portfolio was about 15%. However, there are clinics where it reached 30–40%. There are those where it»s less than 15%. But those who haven«t raised prices now may simply not have had time, it»s all ahead for them.

Alexey Kuznetsov believes that if clinics continue mindlessly shifting problems onto consumers, patients won«t forgive: »Any business in such situations has two options: either you raise prices and shift all costs onto the consumer, or you raise them reasonably and partially shift costs onto the owners. In the second case — yes, profit will fall, but in the long term you«ll level out because sales may not only not fall but even grow. And if you raise the price hoping that the owners won»t suffer, they«ll suffer anyway. Because sales will fall. The situation is not simple, yes, but you need to approach it with intelligence, not as stupidly as some of our medical centers are doing.»