Ayrat Farrakhov: “It is absolutely impossible to count how many minutes the doctor worked with the patient”
State Duma Deputy from Tatarstan Ayrat Farrakhov on how incentive payments to medical workers are regulated
On Friday, May 15, Vladimir Putin harshly criticized the authorities of a number of regions where medical workers did not receive the required incentive payments for working with Covid-19 patients. Ayrat Farrakhov, a parliamentarian from Tatarstan, former minister of healthcare of the Republic of Tatarstan and deputy Mminister of healthcare of the Russian Federation, explains in his column for Realnoe Vremya why this situation may have developed.
What determines the calculation of incentive payments
As you know, the salary of medical workers is about 75% of the expenses of the MHI Fund and 25% of the expenses of the Russian Federation region. In this situation, we will talk about incentive payments due to special difficulties on the instruction of the president. They are made from the Reserve Fund of the Russian Federation. Payments are made in accordance with budget legislation.
There are three key regulatory factors that regulate the provision of services:
- The first is the decision of the president, on the basis of which a government decree allocates the amount.
- The second normative act is the rules that clearly specify how much money is allocated to a particular subject, how this amount is calculated, how the payment procedure will be carried out, and the conditions under which this amount is provided from the federal budget.
- And the third factor is directly normative acts at the local level, which determine the procedure for bringing these amounts to a specific doctor or medical worker.
You should agree that there is a difference between doctors who worked in a medical organization on a part-time or full-time basis. But, of course, this should not be calculated by minutes
Where discrepancies come from
In the case of incentive payments to medical workers for working with patients with COVID-19, the president clearly set the task, and the government decree allocated the amount — that is, the first regulatory factor was not in doubt.
This amount was brought to the relevant departments through the Treasury (our main principle is the treasury system of budget execution).
Two factors remain — either the rules established in April had several possibilities of interpretation, or the regulations of medical organizations did not fully comply with these rules, and there was a delay. Still, I assume that until May 15 (the changes were made on this day) the rules had allowed for several interpretations, and a number of federal subjects apparently interpreted them in their own way — for example, the phrase “for the time actually worked”. This is what the president drew attention to.
As a person who has worked in a hospital and in an intensive care unit for a long time, I can confirm that it is absolutely impossible to actually count the number of people who have worked with a particular patient by minutes. As for hourly pay — we are not talking about a stopwatch, but about the standard working time. You should agree that there is a difference between doctors who worked in a medical organization on a part-time or full-time basis. But, of course, this should not be calculated by minutes. For example, if the driver works for an ambulance, then he has quite specific shifts, and there is no need to calculate with a calculator how much he had contact with a Covid or non-Covid patient. This payment should be calculated based on the fact of contact in principle.
On May 15, the rules were clarified, and the new version removes a number of issues that caused confusion. I think that the situation will improve in the near future. But I would like to emphasize that doctors from Tatarstan have not personally addressed me on these issues and have not sent complaints about insufficient payments.
For example, if the driver works for an ambulance, then he has quite specific shifts, and there is no need to calculate with a calculator how much he had contact with a Covid or non-Covid patient. This payment should be calculated based on the fact of contact in principle
Why the rules may be updated in the future
I think these rules will also be clarified in the future. In this case, I proceed from the fact that today's statistics show that 40-45% of diagnosed cases of COVID-19 are asymptomatic. But with such patients those medical workers could work who were not formally included in the list of those who are supposed to be paid. I think they should receive these incentive payments in the future.
The thing is that the rules regulate the list of which medical workers, clinics and hospitals are involved in providing assistance to coronavirus patients. So far, we are talking directly about doctors who work in Covid-19 centres or in the ambulance. I can assume that this list will be amended in the future.
Their general meaning will be that if any medical professional (even a non-professional) is registered to work with a patient with COVID-19, then they should receive incentive payments. In my opinion, this was the point of the president's order. And, of course, I would like all doctors to receive these payments on time and in full.