A law has been adopted that allows medical institutions, in the absence of debt, to use funds received for the medical care they provide outside the framework of compulsory health insurance (CHI) programs.
Options for spending funds will be established by territorial programs of state guarantees for providing citizens with free assistance, but the law specifies that they cannot be used for investments in construction, reconstruction and major repairs, as well as for the purchase of real estate, transport, securities and shares in the authorized capital of organizations and repayment of the principal amount of loans.
The money can be used to pay for rent for housing for medical workers, renovation of health care facilities, rental of medical equipment, etc. The regional Ministry of Health will need to be notified about upcoming expenses.
The law also extends the period of transition of medical organizations to providing care based on clinical recommendations until 2025.
Information about additional options for the functioning of medical institutions opens the event rating of the week.
In second place in the TOP5 are reports of personnel problems in the industry at the end of 2023.
One in four doctors wants to leave medicine due to overwork, a recent survey revealed. Most often, therapists and anesthesiologists-resuscitators spoke about their desire to leave the profession.
Doctors were asked whether it was customary in their organization to work more than one position. 33% of doctors, as well as 38% of nurses responded that more than 75% of their colleagues work this way in their institutions. The main reasons for this decision were an attempt to increase income (38%) and a shortage of medical personnel (37%).
Three out of four doctors surveyed (78%) responded that they were tired of overwork, with 51% wanting to work less, and 26% wanting to leave medicine altogether.
|The Ministry of Health did not agree with the figures. According to department statistics, the part-time ratio for doctors is 1.3, for paramedical personnel – 1.2, and “overtime not provided for by the Labor Code of the Russian Federation is not allowed.”
Co-chairman of the interregional trade union of healthcare workers “Action” Andrey Konoval called the forced overtime of doctors by 1.5 times the rate or more due to staff shortages “a disgrace for the country.” He recalled that in Russia back in 1917 an 8-hour working day was established.
Konoval noted that despite the fight against personnel shortages announced by the Ministry of Health, since 2012 the number of doctors and paramedics working in state and municipal medical institutions has been decreasing annually in absolute numbers. “The root cause is, of course, extremely low salaries and difficult work, the responsibility that the doctor bears, emotional and physical stress. In this regard, people do not stay in the profession,” he explained.
If some workers quit, the burden on others increases. The only way to solve the problem is a significant increase in wages, adequate to the level of responsibility and workload. However, it should not include possible overtime and part-time work, according to the Action trade union.
The government will allocate an additional over 7.7 billion rubles to co-finance the costs of medical organizations for remuneration of newly hired employees in 2024. The money will be distributed between the budgets of territorial compulsory health insurance funds (TFIF).
St. Petersburg will receive the most funds for these purposes (over 1.2 billion rubles), followed by the Republic of Sakha (Yakutia) – 477.7 million rubles, Kursk region – 414 million rubles, Kemerovo region – 243 million rubles
The decision was made based on the forecast for the annual increase in the number of medical workers, according to which in 2024 more than 9.5 thousand doctors and almost 17 thousand paramedical specialists will come to work in medical institutions.
For 2023, 7.4 billion rubles were distributed to the regions for these purposes. The payments were calculated for 18 thousand doctors and 20 thousand paramedical staff, MV reported.
In November last year, the government approved new rules for the provision of interbudgetary transfers from the MHIF budget to co-finance the salaries of newly hired doctors and nursing staff in medical institutions. When distributing these TFOMS funds, unused balances for the previous period and the “employment index” are now taken into account – the ratio of the number of employed workers to the shortage of medical personnel for the corresponding period.
At the end of last year, the Accounts Chamber called the rate of disbursement of funds intended to co-finance the costs of medical organizations for the remuneration of doctors and paramedical staff low. Money from the normalized insurance stock (NSS) of the TFOMS is distributed without taking into account the regions’ needs for medical workers. According to auditors, as of October 1, 2022, out of 17.3 billion rubles planned for these purposes, only 1.3 billion rubles had been spent. (7.7%).
|NHS funds have been provided to medical organizations to pay newly employed health workers since 2019. But the demand for this support was decreasing: in 2019, 2,803 medical institutions participated in the program, and in the first half of 2021, their number decreased to 2,042.
In June last year, the Ministry of Health expanded the list of medical organizations that are provided with NHS funds to co-finance the costs of paying doctors and paramedical staff, including, in particular, maternity hospitals and dispensaries. In November 2023, the concept of “young specialists” was prescribed in the order.
This news took third place in the week’s event rating.
In fourth place in the TOP5 is information about the extension until January 2025 of permission to work as an ambulance for students.
In the summer of 2022, the Ministry of Health initiated the adoption of Decree of the Government of the Russian Federation No. 1448 of August 19, 2022. According to it, students of medical universities who have completed four courses in the specialties “General Medicine”, “Pediatrics” and “Dentistry”, as well as certified specialists in these specialties, including “Nursing”, are allowed to work as part of emergency medical services teams as a paramedic. Graduates of a specialty in the specialties “General Medicine” and “Pediatrics” have the right to work as an emergency medical technician, subject to accreditation and 36-hour retraining courses in emergency medical care.
Earlier, in an explanatory note to the draft resolution, the Ministry of Health indicated that the implementation of this opportunity “showed a positive result”: over the course of the year, more than 3 thousand people were allowed to practice medicine. And according to information from individual regions (Belgorod, Chelyabinsk, Kursk, Smolensk, Tomsk, Tambov regions, the Republic of Karelia), a “significant proportion” of those admitted precisely according to the adopted resolution work at ambulance stations. Specific numbers were not provided.
Rounding out the top five news is a message about the Ministry of Health’s desire to improve the process of identifying reproductive health diseases in adolescents – it is proposed to reduce the age of examination of girls by a gynecologist from 14 to 13 years.
This need is justified by “a modern approach aimed at early detection of reproductive health diseases in adolescents, taking into account the physiological development of reproductive function.” According to Elena Uvarova, the chief freelance gynecologist for children and youth at the Ministry of Health, this year means a lot, since puberty occurs in adolescence.