The Ministry of Health intends to protect the rights of doctors to federal special payments

The Ministry of Health proposes to additionally protect the interests of about 1 million doctors, nurses and ambulance workers who receive special social payments introduced in 2023 for medical personnel. According to the draft resolution prepared by the department, public hospitals and clinics in which recipients of such federal surcharges work will not be able to reduce their other incentive payments financed from territorial compulsory medical insurance funds. Industry trade unions differed in their assessments of the effectiveness of the proposed measure.

The Ministry of Health proposes to adjust the rules for calculating a special social benefit, which certain categories of doctors and health workers receive from 2023 – a draft government decree on this was published on the regulation.gov.ru portal. Let us explain, at the end of 2022, additional payments from the federal budget were introduced for approximately 1 million healthcare workers (in total, 2.5 million people are employed). Depending on their position and place of work, doctors now receive from 4.5 thousand to 18.5 thousand rubles. monthly in addition to salary. These amounts should compensate medical workers for the government’s gradual abandonment of the practice of payments for providing assistance to patients with coronavirus, which were introduced during the pandemic (for more details, see Kommersant on December 8). Budget expenditures on special payments in 2023 should amount to 152.4 billion rubles.

As follows from the draft resolution, the Ministry of Health proposes to clarify the obligations of employers in relation to health workers receiving such payments – in 2023 and beyond, their salary level cannot be lower than in the previous year. It is also proposed to oblige territorial funds of the compulsory health insurance system (CHI) to monitor the level of salaries of health workers on a quarterly basis and transfer data to the federal compulsory medical insurance fund and Rostrud.

As Mikhail Androchnikov, deputy chairman of the trade union of healthcare workers (part of the Federation of Independent Trade Unions), explains, by proposing these changes, the Ministry of Health first of all seeks to solve the problem of shifting the cost of salaries of healthcare workers from the regional to the federal budget. “The salaries of doctors and nurses consist of several types of payments, among which, in addition to mandatory ones, there are also incentives – for example, for the quality and volume of work. Most medical institutions can assign them at their discretion, and often the share of incentive payments in the employee’s total income can be 30–40%,” says the expert. He notes that when the government introduced federal benefits, many hospitals cut employee incentive payments by a comparable amount.

The presence of the problem is also confirmed by the head of the medical workers’ union “Action” Andrei Konoval. “Judging by the flow of complaints that our union receives from health workers, within a year this practice has spread throughout the country,” he says. According to him, public hospitals and clinics now lack the funds they receive from the compulsory medical insurance fund to ensure their work. Thus, according to the Accounts Chamber, if in the first half of 2022 the volume of accounts payable of these organizations amounted to 2.67 billion rubles, then in 2023 it increased to 6.88 billion rubles. At the same time, according to state auditors, the salary of a health worker makes up the main (69–71%) part of all expenses of medical institutions.

“The amendments proposed by the Ministry of Health will allow better control over the calculation of salaries for health workers. But, most likely, quite quickly there will be a need to additionally finance public hospitals and clinics – usually regional budgets are forced to do this,” says Mikhail Androchnikov. Andrei Konoval, however, believes that medical institutions will be able to continue to reduce incentive payments to those who receive a federal supplement, since the departmental amendment contains a clause on the employment contract. “An employment contract may establish any conditions for the accrual of an optional part of incentive payments,” he notes. Therefore, according to him, salary monitoring may become a more important tool: from the moment the moratorium on inspections is introduced (about its extension see material) It has become several times more difficult for Rostrud to gain access even to budgetary institutions.

Anastasia Manuilova