Doctors couldn’t read the supplement prescription

From January 1, 2023, certain categories of doctors and medical staff should receive additional payments – from 4 thousand to 18.5 thousand rubles. per month. A survey of the professional service “Action Medicine” showed that the heads of many medical organizations have not yet figured out which of their employees can qualify for additional payments. Experts with whom Kommersant spoke note that the criteria for receiving payments are “too complicated” and not fair in all cases. The Ministry of Health claims that they are ready to deal with each appeal for non-payment.

In December 2022, President Vladimir Putin instructed to allocate additional social benefits to certain categories of health workers. In pursuance, the government issued Decree No. 2568, according to which, from January 1, 2023, doctors in central district hospitals receive an allowance of 18.5 thousand rubles. per month, primary care physicians – 14.5 thousand rubles; emergency doctors – 11.5 thousand rubles; specialists with secondary medical education in central, district and district hospitals – 8 thousand rubles; paramedics and nurses of ambulance stations (departments) – 7 thousand rubles; junior medical staff of these institutions – 4.5 thousand rubles. The exceptions were the heads of medical organizations and their deputies, as well as cases of internal and external part-time jobs. It should be noted that the resolution affects only organizations of state and municipal subordination that operate in the system of compulsory medical insurance. At the same time, it is recommended that the regions, at their own expense, establish special social benefits for health workers who provide assistance outside the basic compulsory medical insurance program, for example, phthisiatricians and psychiatrists-narcologists who see patients in polyclinics, but are actually attached to anti-tuberculosis and psychiatric dispensaries.

Service “Action medicine” conducted a survey among 2416 users – doctors and health workers with secondary medical education. It turned out that 46.6% of respondents know for sure that they are entitled to payments; 12.1% are sure that they do not rely on them (they did not participate in the further survey). At the same time, a significant proportion of respondents – 41.3% – did not figure out whether the decision concerns them. Of these, 18% are doctors and paramedical personnel of outpatient clinics, 15% are doctors and paramedical personnel of central district hospitals, district and district hospitals. According to the decree, all these categories are entitled to payments.

Next, the researchers divided the respondents according to their position and interviewed those who meet the criteria for the ruling. It turned out that additional payments for the first quarter of 2023 were received by 70% of the respondents from among the nursing staff and 55% of the doctors of the Central District Hospital, district, district hospitals. For the second quarter – 69.1% and 56% respectively. 1% of the interviewed workers of paramedical staff and 2% of doctors indicated that they did not receive additional payments for the entire period, and 6% and 12%, respectively, believe that the amount of payments was lower than those established in the decision. In the first quarter of this year, 62% of mid-level workers and 61% of doctors received a bonus in outpatient clinics, and 58% of the respondents of both groups received a bonus in the second quarter. 4% of nurses believe that they receive payments below the established ones, and the same number say that they were not paid for the entire period of the decision. Among physicians, these figures are 4% and 2%, respectively.

Half of the health workers surveyed (51%) reported that they themselves studied the decision or looked for the answer in help systems. A fifth of the respondents (20%) were not interested in the calculation method, but simply asked the authorities to report the due amount – the authors of the survey believe that in such cases there could be doubts whether the accrued amount complied with the decision.

Those who were supposed to receive payments, but did not wait for them, were asked if they knew the reason? 60% of them answered that they did not know. The rest received a variety of answers from the authorities: from “they figure out if we are supposed to” to “they said who is on decree is not supposed to.” Some dissatisfied with the lack of payments or their size applied “to the prosecutor’s office and the ministry”, but “everywhere they received a different answer.” In some cases, they sought payments, but not in the expected amount – for example, 6.5 thousand rubles. instead of 8 thousand

Andrey Konoval, co-chairman of the interregional trade union of medical workers “Action”, claims that there was “confusion” with payments. “This is largely due to the fact that in our structures of medical institutions there is a mixture of functions of medical workers,” he says. “For example, in the Glazov interdistrict hospital (Udmurtia.— “Kommersant“) the medical staff of the emergency room, in the absence of traumatologists and surgeons in the polyclinic, actually conducts an outpatient appointment, for which payments should have been made. But since medical workers formally belong to a hospital, they do not receive payments.”

Andriy Konoval also notes that the resolution is interpreted “ambiguously” in the regions. As a result, a number of categories – for example, head nurses, doctors attached to preschool and school institutions, phthisiatricians and psychiatrists – “somewhere receive allowances, somewhere they do not.” Because of this, Mr. Konoval notes, “social tension” arises. In general, the trade union believes that some categories of health workers are “unfairly and illogically” deprived of payments: for example, employees of district hospitals are entitled to additional payments, but physicians of interdistrict hospitals are not. Trade union activists applied to the Ministry of Health and the government about this, but received no response. So far, the authorities have agreed to expand the scope of the document only to employees of clinical diagnostic laboratories, says Mr. Konoval.

Larisa Popovich, director of the Institute for Health Economics at the Higher School of Economics, notes that payments are made through the Social Fund, a channel that is “quite well developed.” The problem, in her opinion, may be that the decree includes many mandatory conditions and is “very unclear” for medical staff and heads of medical organizations. Each case of unreasonable refusal to pay should be dealt with separately, she believes. However, Mrs. Popovich calls the idea of ​​additional payments “patch”, believing that it is necessary “in principle to equalize the salaries of doctors in all regions.”

The Ministry of Health told Kommersant that for the implementation of Decree No. 2568 in 2023, the FFOMS budget provides for 152.4 billion rubles. The agency clarified that special social payments are made by the territorial offices of the Social Fund of Russia according to the registers of employees entitled to receive additional payments. Their fund is provided by the medical organizations themselves. According to the latest data of the Social Fund, in January-June 2023, registers of 4367 medical organizations were provided. In accordance with them, we are talking about payments to 900 thousand medical workers in the amount of 38.2 billion rubles. It should be noted, according to Rosstat for 2022, in Russia there are more than 574 thousand doctors, more than 1 million 279 thousand workers of paramedical and pharmaceutical personnel and more than 285 thousand workers of junior medical staff.

“The appeals received by the Ministry of Health of Russia from medical workers, medical organizations, constituent entities of the Russian Federation are clarified on the application of Decree No. 10 rules approved by government decree No. 2568 provide for the responsibility of a medical organization for providing false information or concealing information that affects the right of an employee to receive a special social payment.

Natalya Kostarnova