Do not work more expensive for yourself – Newspaper Kommersant No. 153 (7354) of 08/23/2022

The Ministry of Health has developed a draft federal law that will increase contributions from regional budgets to the compulsory medical insurance system for the non-working population. According to the agency, when calculating these amounts, it is necessary to use not only the inflation rate, but also the increase in wages – according to forecasts, in the coming years it should exceed the rate of price growth. As a result, by 2025, the constituent entities of the Russian Federation will pay more than 1 trillion rubles for medicine for the unemployed, children and pensioners, while, as Kommersant’s interlocutors in the government admit, some of these funds, in turn, can be used to increase medical salaries. workers.

From 2023, regional budgets will face an increased increase in the cost of contributions to the MHI system for the unemployed. The draft federal law on this, developed by the Ministry of Health, is published on regulation.gov.ru.

As of January 1, 2021, as follows from the draft FFOMS budget for 2022-2024, the number of non-working Russians insured under compulsory medical insurance was 81.3 million people. Based on this document, in 2022-2024 the regions would have to transfer 813.8 billion rubles, 846.5 billion rubles to the budget of the FFOMS for them. and 880.5 billion rubles. respectively. The formula for calculating these amounts is based on the cost of the tariff for the non-working population according to Federal Law-354 – this is 18.9 thousand rubles multiplied by the differentiation coefficient (takes into account the socio-economic situation of the regions) and the coefficient of appreciation of the cost of medical services, reviewed annually by the fund. For 2022-2024, the latter was to be 1.244, 1.294 and 1.346, respectively.

As follows from the explanatory note to the draft of the Ministry of Health, the department proposes to change the approach to calculating this coefficient, including not only forecast inflation (consumer price index, CPI), but also an additional indicator – the growth rate of the average monthly accrued salary of employees of organizations in the previous calendar year. The weight of the new indicator in the calculation formula should be 70%, the remaining 30% will be the contribution of the CPI. As a result, as the department indicates in the financial and economic justification, according to the updated formula, the coefficient will be 1.372 in 2023, 1.483 in 2024, and 1.581 in 2025. This, in turn, will lead to an increase in the regions’ expenses on contributions for the non-working population to 902.2 billion rubles, 975.2 billion rubles. and ?1.039 billion rubles. respectively.

An increase in regional spending in 2023–2024 compared to the forecast values ​​included in the FFOMS budget for 2022–2024 by 55.5 billion rubles. and by 94.7 billion rubles. caused by the higher projected wage growth compared to the inflation rate. So, as Nikolai Avksintyev, adviser to the director of the NIFI of the Ministry of Finance, explained to Kommersant, according to the forecast for the socio-economic development of the Russian Federation, which was published by the Ministry of Economy in May this year, in the base case, inflation at the end of 2023 is expected to be 6.1%, and in 2024 and 2025 – 4% annually. At the same time, the growth rate of the average monthly nominal wage in 2022 is projected at 12.1%, in 2023 – 9.9%, in 2024 – 7.7%. “Substituting these values ​​into the current and proposed methodology for calculating the coefficient of appreciation of the cost of medical services, we can conclude that the adoption of the proposed changes will lead to an increase in the tariff for compulsory medical insurance for the non-working population in 2023 by 3.9%, in 2024 by 8%, and in 2025 – by 10.7% compared to the current rules,” he said.

As a source in the financial bloc of the government explained to Kommersant, the proposal of the Ministry of Health to increase contributions to regional budgets may be due to the need to allocate additional funds to pay salaries to doctors – in the MHI budget, most of the funds (up to 70%) are spent precisely for these purposes. “Since no one canceled the May presidential decrees of 2012, the salary of medical workers should be at least 200% of the average salary in the region for doctors and 100% for middle and junior medical staff. At the same time, in the current methodology, the amount of contributions to compulsory medical insurance of the non-working population is tied only to inflation, which is almost always lower than the growth rate of nominal wages of workers. As a result, there is a discrepancy between the dynamics of income and expenses of the compulsory medical insurance fund, which this bill is aimed at eliminating, ”he notes. It should be noted that the ability to provide medical workers with the promised level of salaries may be especially important for the government now – a change in the procedure for payments to those who work with patients with coronavirus will inevitably lead to a drop in their income after almost two years of growth, while the transition to a new wage system in industry (OSOT) was postponed until 2025 (for more details, see Kommersant-Online of June 15).

The proposal of the Ministry of Health to increase the contributions of the regions is likely to fix the status quo in the long-term discussion about the extent to which they should participate in the CHI system. In recent years, the heads of the subjects have repeatedly proposed transferring the obligation to pay for the unemployed to the federal level, arguing that they want to spend the released funds on regional medical care programs. The Ministry of Finance has traditionally opposed them in this dispute – perhaps, the increase in regional budget revenues for the first half of this year by a quarter helped to argue its position this time. In addition, earlier the department did not agree on the allocation of additional funds from the federal budget for the implementation of OSOT, the cost of which for the whole country would exceed 500 billion rubles. in year. And under these conditions, an increase in contributions for the regions could be the only way out for the Ministry of Health, says a Kommersant source.

Anastasia Manuylova