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- Pain is a tricky thing to think of: why the Ministry of Health is changing the procedure for issuing sick leave certificates
Pain is a tricky thing to think of: why the Ministry of Health is changing the procedure for issuing sick leave certificates
The procedure for issuing sick leave may be changed in Russia. Doctors will be able to issue a new certificate of incapacity for work to citizens who have been off work due to illness four or more times in six months for only three calendar days. Cases requiring long-term treatment will be considered individually by a medical commission. The approach may stimulate employers and employees to be more active in disease prevention, but there is a risk that employees will start carrying diseases "on their feet" more often, experts warn. For what the Ministry of Health is changing the rules - in the material "Izvestia".
Sick leave from September 1, 2025
The procedure for the formation of certificates of incapacity for work in Russia want to change. The corresponding initiative of the Ministry of Health published on the portal of draft regulatory legal acts.
Under the new rules it is proposed to take into account the number of already issued certificates of incapacity for work. This, as expected in the Ministry, will help to identify the causes of the patient's condition and promptly take measures to improve the provision of medical care.
The main change will affect Russians who went on sick leave four or more times within six months. There will be a restriction for them: a certificate of incapacity for work will be issued to such citizens for a period of up to three calendar days.
Exceptions to the new order will be cases of care for a sick relative, medical rehabilitation, assistance in socially significant diseases and diseases requiring treatment with renal replacement therapy.
If adopted, the order of the Ministry of Health will enter into force on September 1, 2025. Its validity is limited to September 1, 2031.
Izvestia editorial board sent an inquiry to the Ministry of Health of the Russian Federation. At the time of publication, no reply had been received.
How to issue a sick leave
At the moment, the procedure for issuing a sick leave is quite simple, points out obstetrician-gynecologist Victoria Fursova.
- The patient, feeling sick, goes to the polyclinic or calls a doctor at home. After the examination, the medical worker issues an electronic certificate of incapacity for work," the doctor explains.
It is created on the basis of the Unified Information System "Social Insurance" and is automatically sent to the Social Fund of Russia. There is no need to duplicate it in paper form, says Alexei Nezhivoy, head of the operational headquarters of the independent trade union Novy Trud. Notification of the opening of a sick leave certificate appears in the personal account on the Gosusgoservices portal within two calendar days.
- It is not only about injuries and illnesses. Sick leave is entitled to quarantine, dental prosthetics in hospital, pregnant women in a condition that threatens the future child, as well as citizens caring for sick children, and so on, - lists the interlocutor of "Izvestia".
The period of sick leave is determined based on the severity of the disease, the general condition of the patient and clinical recommendations, Fursova notes.
The minimum duration is not fixed by law, but usually a sick leave is issued for at least three days, says Alexei Nezhivoy. In general, in outpatient treatment, a doctor can issue a sick leave for up to 15 calendar days, and a dentist - up to 10.
For a longer period of time the sick leave can be obtained only by decision of the medical commission, emphasizes the representative of the trade union.
- It extends the sick leave for up to 10 months and sometimes up to a year. However, in this case, the employee must appear every 15 days for examination," explains Nezhivoy.
Fighting the abuse of sick leave
The purpose of the reform announced by the Ministry of Health is to optimize the system of issuing sick leaves, improve control over the quality of medical care and increase the effectiveness of preventive measures, says Ilya Rusyaev, managing partner of Rusyaev & Partners, lawyer.
The Ministry's initiative will make it possible to monitor the health of able-bodied citizens more effectively, identify chronic and recurrent diseases in time and propose preventive measures, adds Victoria Fursova. This can improve the overall health of Russians and reduce the burden on medical institutions.
- Frequent applications for sick leave may be a signal of chronic health problems or insufficient diagnostics. The new procedure involves analyzing such cases in order to identify the root causes of diseases and eliminate them in a timely manner," Rusyaev points out.
In addition, one of the main reasons for changing the order of issuing sick leave was the government's desire to increase the efficiency and expediency of social guarantees, says Sean Betrozov, a practicing lawyer of the Moscow Chamber of Lawyers, a member of the Russian Bar Association.
- The existing system, in which certificates of incapacity for work can be issued repeatedly and for long periods of time, raises concerns about possible abuse. Four or more sick leaves in the last six months may indicate that in some cases people use sick leaves as a way to avoid work, even without serious illnesses," the expert believes. In this case, limiting the period to three days will help reduce abuse and encourage citizens to take more active care of their health.
Sick leave for long-term treatment
Cases in which patients require long-term treatment will be considered by a medical commission on an individual basis, Ilya Rusyaev points out. Based on its results, a decision will be made to extend the sick leave, based on the analysis of the patient's medical history and assessment of the effectiveness of treatment and rehabilitation measures.
- In complicated cases, such as chronic diseases, the commission may refer the patient to a medical and social expert assessment to decide on disability or recommendations for further treatment. This innovation should minimize the likelihood of denying assistance to those who really need it," the Izvestia interlocutor said.
The medical commission not only decides on the extension of sick leave, but also takes responsibility for the patient's health, assessing his condition on a regular basis, emphasizes Sean Betrozov.
The introduction of the medical commission as a mandatory element of the extension of sick leave also carries an important aspect. It ensures a high level of medical expertise and eliminates a subjective approach, the expert adds.
- Doctors will be obliged to assess the patient's condition not only according to his words, but also on the basis of objective medical evidence, which should improve the quality of care provided. For the patient it can be an additional guarantee that his treatment will be adequate and timely, - Betrozov is convinced.
However, the extension of sick leave based on the decision of the medical commission will add bureaucratic burden to medical institutions and patients, warns Victoria Fursova.
Abuse of sick leave
The expediency of such strict time limits raises questions, says the doctor. On the one hand, they may become a solution to the problem of unjustified use of sick leave. On the other hand, in the proposed form, the restrictions may have a negative impact on patients who really need longer treatment.
- In my opinion, it is important to work out the exceptions in more detail and provide for additional mechanisms that will help identify hidden health problems and not infringe on patients' rights," Fursova points out.
Ilya Rusyaev believes thatthe Health Ministry's initiative may encourage employers and employees to be more active in preventing diseases, strengthening immunity and seeking medical help at an early stage.
More stringent measures may stimulate employers to create conditions for disease prevention in the workplace, does not rule out Sean Betrozov.
- The introduction of corporate health programs and the creation of conditions for employee recreation and rehabilitation will significantly reduce the frequency of requests for sick leave. In addition, limiting the duration of sick leave can help improve labor discipline and reduce the financial burden on the social insurance system," the expert is convinced.
But there is a risk that patients, fearing the short-term nature of sick leave, will try to carry the disease "on their feet", which is fraught with complications and the spread of infections in the team, Rusyaev warns.
- At the same time, many diseases, especially those with weakened immunity or chronic conditions, require more time to recover, and three days may not be enough. People may find themselves in a situation where they are forced to return to work without completing full treatment. Ultimately, this could lead to a deterioration of their health and more serious problems," Betrozov admits.
New rules for issuing sick leave - a step towards transparency
Despite certain inconveniences that may arise due to the restrictions, the new rules have positive sides, the lawyer believes. They will help improve control over the use of sick leave, minimize possible abuse and encourage citizens to be more responsible towards their health.
- Of course, for some people it may become an additional burden. But it should be understood that the changes are primarily aimed at supporting those who really need medical care and at ensuring fairness in the distribution of social guarantees," the expert is convinced.
However, Ilya Rusyaev warns that it is premature to assess the effectiveness of the initiative.
- Its success will depend on how effectively the system of control and interaction between doctors, patients and employers can be built. It is important that the goal of the reform - to improve the health of the able-bodied population - not get lost among possible bureaucratic difficulties," emphasizes the Izvestia interlocutor.
But we can already say that the new rules are a step towards a more transparent and fair healthcare system, where social guarantees are distributed based on the real needs of citizens, summarizes Betrozov.
