Doctors were prescribed money in small doses – Newspaper Kommersant No. 218 (7419) dated 11/24/2022

Until the end of this year, the regions of the Russian Federation will receive almost 59 billion rubles. to increase the salaries of doctors, middle and junior medical personnel. As follows from the changes proposed in the methodology for distributing these funds, they will go directly to the regional ministries of health and will be used to pay only to those categories of specialists that are in the May 2012 presidential decree. Perhaps with the help of such transfers, the government seeks to soften the postponement of the systemic reform of doctors’ salaries to 2025.

The government introduced changes to the methodology for distributing subsidies from the reserve fund to increase the salaries of doctors in the regions – a draft resolution of the White House was published on the portal pravo.gov.ru. Earlier, we recall, Prime Minister Mikhail Mishustin promised the regions to allocate 58.6 billion rubles so that the salaries of doctors and medical staff in the regions do not lag behind the average for the economy in terms of growth rates. This indicator, according to the Ministry of Economy, will amount to 11.5% by the end of the year. Thanks to the May 2012 presidential decree, the regions are obliged to maintain the level of salaries of certain categories of state employees in a fixed ratio with the average for the constituent entity of the Russian Federation. For doctors, as well as middle and junior medical staff, it is 200%.

At the end of October, the government published a methodology for distributing the reserve fund by region: taking into account the proposed formula, the largest subsidies should have been received by entities with the maximum number of medical workers, including Moscow, the Moscow Region and St. Petersburg.

The funds, as is usually the case in such cases, were supposed to go to the budgets of the territorial CHI funds, and from there to specific medical institutions for “financial support for medical care.”

The new resolution introduced amendments to the methodology, which will probably make the spending of the allocated funds more targeted, as well as simplify the collection of reports on it. So, now the purpose of the payments is called “financial support for wages and accruals for wage payments of certain categories of medical workers.” This, as indicated in the document, is only about those specialists who were originally listed in the May presidential decree.

The recipient of these funds has also changed: if earlier they had to be transferred to the territorial CHI funds, now they will go to the regional ministries of health.

They, in turn, are now formally directly subordinate to the federal ministry, which is likely to allow the latter to better control spending.

It should be noted that taking into account the total size of the payroll fund for medical workers – and it can be up to 70% of the annual budget of the compulsory medical insurance system (2.8 trillion rubles in 2022, of which about 2 trillion rubles go to salaries) – the funds allocated by the government hardly significant: it is about 3% of the sectoral payroll. However, their intended purpose for raising the salaries of certain categories of health workers, apparently, will make it possible to bring them as close as possible to the standard. On the other hand, the increase in average wages at the end of the year may turn out to be higher than the forecast of the Ministry of Economy – as Kommersant already wrote, their growth was stimulated by partial mobilization and increased competition for specialists between employers (more see “Kommersant” dated November 19).

Despite the relatively small potential impact of new transfers on the situation with salaries in the medical industry, testing the mechanism of their accrual and especially the collection of reports on their use may in itself indicate the government’s readiness to continue reforming the wage system in the industry. Those proposals that were developed for a systematic increase in the salaries of medical workers earlier by the Ministry of Labor and the Ministry of Health – the OSOT reform – were postponed until 2025 due to a lack of federal budget funds. As previously wrote “Kommersant”, it was about 600-700 billion rubles. additional transfers to the CHI system annually. The current transfer gives the government the opportunity to fine-tune the system for transferring funds to the industry without major systemic changes and to a lesser extent.

Anastasia Manuylova