Personnel - reserves: by how much they plan to raise doctors' salaries
Health Minister Mikhail Murashko spoke at the 10th Plenum of the Central Committee of the Russian Health Workers' Trade Union. At the event they talked about the profile budget for 2025, as well as how to increase doctors' salaries through proper organization of work and savings. The issue becomes all the more urgent because next year is scheduled to start a pilot project to create a unified system of labor remuneration for public sector employees, including medical workers, which should work everywhere from 2027. However, there is no list of clear parameters of the project and the regions that will take part in the piloting, and they did not appear during the plenum. Read more about what to expect in material terms from the next year to medics - in the material "Izvestia".
How the budget for health care is growing
In his speech, Mikhail Murashko said that since 2019, the budget of the Mandatory Health Insurance Fund has increased more than 2.2 times; also, investments in medical infrastructure within the framework of national and federal projects amounted to more than 1 trillion rubles.
Next year, the healthcare budget will increase from all three sources: funds from the compulsory health insurance, the federal budget and regional budgets - a total of 13%, Guzel Ulumbekova, head of the Higher School of Organization and Management of Healthcare, Doctor of Medical Sciences, told Izvestia.
-This is plus 865 billion rubles relative to 2024," she noted. - If we subtract inflation, for which the budget forecast is 4.5%, the increase will amount to 8%.
According to her, the additional money will be used, among other things, for indexation of wages of medical workers by 13%, so that the wages meet the requirements of the May decrees of the President.
- The good news is that the budget is not reduced, but, on the other hand, the funds for the new system of labor remuneration, which should start nationwide in 2027, have not been allocated yet, " the expert emphasized.
When the pilot project will start
At the plenum Mikhail Murashko reminded that the pilot project should start in 2025, and the full transition to the new system of labor remuneration - in 2027. According to the Minister, this transition will be "discussed separately" with the participation of the trade union. When asked by the Izvestiya correspondent when and in which regions the project would start, the minister did not give any additional information.
Marina Maslova, Director of the Department of Labor Remuneration, Labor Relations and Social Partnership of the Ministry of Labor of the Russian Federation, said in her speech at the plenum that the work on the development of new payment systems in health care and other branches of the social sphere "is complicated both in modeling and in subsequent implementation".
Recall, the launch of the pilot has been discussed since 2021, but it has already been postponed several times for various reasons. Co-chairman of the trade union "Action" Andrei Konoval in a conversation with Izvestia admitted that the project will be launched only in the fourth quarter of 2025.
The Trade Union of Healthcare Workers of the Russian Federation has a more optimistic view of the situation. Anatoly Domnikov, chairman of the trade union, noted that the skeptics who doubted that the project would be launched were wrong.
-Now the federal level is discussing the extent to which the concept previously approved but not implemented for a number of objective reasons will become the basis for the development of a new version. And we, of course, will again actively participate in this process," he said in his speech at the plenum.
At the same time, the President's instruction to increase the share of salary in the wages of doctors to 50% in 2024 has not been fulfilled everywhere, the union said, citing operational data.
- We conducted an anonymous blitz poll in online format in social networks: out of 6.6 thousand respondents, almost a third of them noted a decrease in their salaries as a result of changes in the mechanism of its formation, - said Anatoly Domnikov at the plenum. - Even taking into account that these are unverified answers, it is important to emphasize that employees perceive the situation in this way. Therefore, it is necessary to thoroughly convey the meaning of this work and analyze it, interacting with managers at all levels.
What the Ministry of Health proposes
In his speech, Mikhail Murashko focused, in fact, on the management of processes in health care: quality organization of activities at all stages will save money, including for the salaries of medical staff, the Minister stressed.
He sees one of the reserves in the use of technology in diagnostic and treatment centers.
- It is precisely about organizational principles. When medical care becomes highly effective - high-flow centers appear in the regions without downtime of equipment, where gastroscopy, colonoscopy and other examinations are performed in a stream version, - said the Minister. - If a digital circuit is introduced in parallel, then the time of a doctor and a nurse is used as efficiently as possible.
According to him, "lean technologies", in which the time spent by staff is minimized, ultimately affect the payroll.
The next aspect the official pointed out is minimization of prices for medical products through the use of Russian-made drugs and products.
- We have come to the point where 70% of drugs from the list of vital drugs are domestic. This has already resulted in huge savings of financial resources, - said the Minister. - The efficiency is mostly at the level of figures within 20%. Therefore, for us the development of production, science is an economic component, which affects, among other things, our salaries, as we effectively use the resources of the procurement system. All this is ultimately our wages.
According to the head of the Ministry of Health, treatment in accordance with clinical recommendations and centralized purchase of drugs, which are prescribed there, will help to save money. According to him, it will also help to assess the efficiency of resource utilization and "executive discipline" in medical institutions.
It should be noted that clinical recommendations, although they will be advisory in nature, but the criteria for assessing the quality of medical care tied to them remain mandatory. Guzel Ulumbekova explains that many doctors in the medical community are wary of these changes, as it may lead to an increase in the number of court cases against them. In her opinion, it is better to assess the quality of medical care based on final indicators, as in all developed countries: health, survival rate and patient satisfaction, hospital-acquired complications and others.
Mikhail Murashko also called in his speech for building a system of planning the need for medicines and equipment. According to him, the write-off of medicines "should be extremely rare", and when ordering equipment, chief physicians should clearly understand what the load should be on it.
Another aspect that can have a positive impact on saving money is the main focus on the primary care, which will stop the flow of patients in the subsequent stages of health care. Now the cost of treatment at the hospital stage is inflated, so the efficiency of the health care system falls sharply on the final indicators, the minister pointed out.
Is it possible to increase wages at the expense of savings
Andrei Konoval believes that there are no resources for a significant increase in wages in the existing health care system. According to him, the share of the labor fund in the total costs of the medical industry is too large for the savings of the remaining funds to free up any serious money to supplement salaries of doctors. According to Guzel Ulumbekova, this figure is about 70%. She also believes that the money saved will not be a serious help in solving the staffing issue, especially since not always they go specifically to doctors: it is often necessary to solve problems with the repair of premises, the purchase of additional medical products, etc.
Expert "Popular Front. Analytica's Sergei Voytyuk emphasizes that the MHIF budget is annually executed with a surplus, although its deficit is planned. At the end of 2023, the surplus amounted to Br104.8 billion instead of the planned deficit of Br147.08 million.
-These funds could have gone to the regions to increase the salaries of medical workers, but according to the Accounts Chamber of the Russian Federation, every year medical organizations in the regions under-receive MHI funds for the provided medical care due to the excess of the volume of medical care allocated by the commission for the development of the territorial MHI program," he told Izvestia.
This, among other things, may be related to the hidden deficit of territorial MHI programs, he believes: "For example, for 2023, the total amount of over-volumes not paid to medical organizations amounted to 23 billion rubles."
Experts emphasize that the calls for efficient spending of funds are correct in themselves. However, Sergei Voytyuk believes that the problem requires "not only local optimizations, but also a revision of the federal policy of distribution and use of budget funds". In particular, an increase in health care spending in Russia to at least 5% of GDP from the level of about 3.5% of GDP at which health care financing in Russia will be in 2025.
-To gradually increase this figure to 5% by 2030, we need to inject about Br700 billion - Br1 trillion into the industry every year in addition to the inflation rate," said Guzel Ulumbekova. - Of this, at least Br500 billion is needed to implement the new wage system.
