The federal government recently introduced incentive payments to health workers in 2020. The purpose of such government assistance is to encourage health workers to be motivated in their work. What are the conditions and procedure for obtaining material support?

Regulations governing the provision of benefits

The regulation of incentive payments to health workers in 2020 is carried out on the basis of several regulations. The first of these is, namely article 129. It specifies the concept of wages and types of payments to employees of organizations.

Another regulatory legal act is the Decree of the Government of the Russian Federation of 08/05/2008 N 583 (as amended on 01/19/2019) "On the introduction of new pay systems for employees of federal budgetary, autonomous and state institutions and federal state bodies, as well as civilian personnel of military units, institutions and subdivisions of federal executive bodies, in which the law provides for military and equivalent service, the remuneration of which is carried out on the basis of the Unified tariff scale for remuneration of employees of federal state institutions "(together with the" Regulations on the establishment of remuneration systems for employees of federal budgetary, autonomous and state institutions "), which establishes the remuneration system for people working in budgetary, autonomous and state-owned enterprises. There is also the Order of the Ministry of Health and Social Development of the Russian Federation of December 29, 2007 N 818 "On approval of the List of types of incentive payments in federal budgetary, autonomous, state institutions and clarifications on the procedure for establishing incentive payments in these institutions" (with amendments and additions ), fixing the list of incentive incentives, factors by which determine the possibility of providing a supplement to wages.

Lists a list of performance indicators that are necessary to address the issue of incentives for workers.

Local Incentive Payout Document

Each hospital must develop its own document that governs employee benefits. It is called the "Regulations on the payment of incentive bonuses to medical workers" and is considered an addition to the collective agreement, which is drawn up for one year.

This document should contain the following data:

• the source from which funds are allocated to pay incentives for health workers;
• a list of employees who are eligible for additional payments;
• money charging procedure;
• the amount of the monthly surcharge;
• a list of criteria that are used to check the quality of the work of the personnel of a medical institution.

The model of the Regulation on Incentive Payments for Healthcare Professionals in each hospital is practically the same.

Who has the right to qualify for material incentives?

In order to receive incentive payments for medical workers, a specialist must be certified in a specialty. Also, the employee needs to show good work. After all, when deciding on the incentive, the performance of each employee of the medical institution is taken into account.

The regional government itself establishes a list of positions that are entitled to receive cash benefits. The following health workers do not fall into the privileged category:

• administration of the institution. Managers can count on material incentives, but only if they directly provide medical services;
• health workers who take part in the "Health" program, namely, provide assistance in the process of childbirth, caring for babies, as well as other doctors who work with them;
• employees of medical institutions providing high-tech assistance.

Criteria by which the work of medical personnel is assessed

Incentive payments to doctors are assigned after the quality of their work is assessed. During the audit, the following factors are taken into account:

1. The quality of the work done in a month.
2. The volume of provided honey. services.
3. Duration of work in the institution.
4. The number of continuous work experience.
5. Skill level.
6. Part-time work.
7. Individual multiplier.

In connection with the presence of these factors, it becomes clear that the implementation of material incentives for hospital workers depends entirely on how the work will be done. This is the optimal motivation for healthcare workers.

Accrual procedure

The procedure for calculating incentive payments to health workers is regulated by a local document, which sets out the rules for remuneration in the hospital. At the end of each month, the chief prepares an order according to which medical workers are paid material incentives.

Also, at the end of the month, management should create a list of employees with information about the work they have done. If the doctor has not coped with his official duties, then the allowance may not be issued. The decision to award the promotion is made by a special commission, which includes:

1. Trade union chairman.
2. Head nurse.
3. Head of the department.

The medical staff is notified of what marks they received for their work. The commission evaluates the activity according to the point system. For the refusal to provide presidential payments to health workers in 2020, serious grounds are needed. For example, a doctor did not fulfill his duties or grossly violated labor discipline.

If in the accounting department the employee was not given a bonus, then you need to demand the provision of an order, on the basis of which the accountant acts. It must indicate the reasons for the negative decision. If the employee does not agree with the decision of the management, then he has the right to appeal it.

In addition to incentive payments, doctors and all other workers in the medical field are entitled to a number of other state preferences. These include:

• years and others;
• preferential consumer.

Approximate calculation of the amount of the markup

The calculation of incentive payments to health workers is made depending on the work done. For example, a doctor's salary is 20 thousand rubles. The increasing coefficient after evaluating the work according to the established criteria is 0, 2. As a result, the material incentive will be equal to 4 thousand rubles. This calculation example is approximate and depends on many factors.

Do you receive payments when combining and replacing?

In accordance with the Regulation on Incentive Payments to medical workers, people who replace other employees are also provided with additional monetary compensation. But at the same time, the documentary procedure for registration of part-time jobs must be observed.

That is, an employment contract is concluded with the employee on the combination of positions. If it is stipulated within the framework of the main employment agreement, then the premiums are not made.

There are no changes yet regarding incentive payments to health workers in 2020. This program is a really good motivation for doctors. The state is trying to do everything to make the salary of medical personnel worthy of this profession.

State programs related to the health sector were put into effect in 2011, although the preconditions for an increase in the salary of medical workers to 200% of the average salary in the region appeared much earlier. The main goals of the programs are to ensure the availability of medical care by attracting additional staff and doctors to work in polyclinics, as well as rewarding individual medical workers for their efforts at work. In particular, incentive payments to health workers were approved, designed to orient employees of medical institutions to the result.

Who is eligible to qualify for incentive payments to health workers

The condition for calculating incentive payments is the presence of a certificate in the main specialty of the established form.

The system for calculating incentive payments has radically changed the scheme for calculating the salaries of doctors and nurses, but the program applies only to certain categories of health workers. Incentive charges are not entitled to:

• representatives of the administration of a medical institution (those managers who are practicing doctors are entitled to participate in the program);
• high-tech care providers;
• Healthcare participants (births, newborn caregivers, pediatricians, family doctors, community physicians and nursing assistants).

On the remuneration of medical workers

The Labor Code establishes the following types of payments to public sector employees:

• basic (basic, fixed, paid to all employees without exception);
• compensatory (changing depending on the region and depending on the conditions of employment);
• social;
• stimulating (depending on the merits of the employee and the assessment of the effectiveness of his activities).

Of all the types of charges listed above, only incentive payments to medical workers are regulated by the administration of the medical institution itself, the rules for assigning the remaining payments are established by federal and regional regulations. The management of the institution is obliged to fix the procedure for paying incentive allowances in a local regulatory act and to familiarize all employees of the clinic with its provisions.

How much incentive payments to health workers are charged

The size of the incentive salary supplement is not fixed - the amount of the supplement will depend on the volume of services provided by the health worker. Every month, the clinic's administration issues an order on material incentives for employees who deserve a bonus. The amount of the copayment for each medical institution is set at its own discretion, but taking into account the main mandatory provisions of the methodology developed by the local Ministry of Health.

When assigning an incentive allowance to each employee, the following indicators are assessed:

• actually worked time during the month;
• the fact of compliance with the standards for the provision of medical care to the population;
• assessment of the effectiveness of the work of a medical worker.

Whatever criteria the employer evaluates when calculating incentive payments, he must indicate them in the local Regulations on remuneration. At the same time, the minimum amount of allowances within the institution should not be lower than the regional indicators prescribed in the legal acts of the Ministry of Health of the constituent entity of the Russian Federation.

Who develops the criteria for encouraging health workers

Initially, recommendations regarding the calculation of incentive payments and methods for determining their size come from the Ministry of Health and Social Development. All medical institutions are guided by them, setting incentive surcharges in an amount not lower than the minimum amounts specified in the Regulations of the Ministry of Health. The decisions made by the administration of the polyclinic regarding salary increments are recorded in the local Regulations on incentive payments, which should indicate the criteria for evaluating the work of employees, the minimum and maximum amounts of additional payments.

What is union control

Prior to approving the Regulations on the appointment of incentive allowances, the higher authorities consult with the trade unions. This scheme for the adoption of regulations is called a tripartite commission, where employers participate. It is collected every year, that is, medical institutions receive guidance on determining payments also annually. Therefore, local Regulations on incentive surcharges should be reviewed regularly. The document states:

• criteria for evaluating the effectiveness of the work of employees;
• the procedure for calculating payments (must be divided into payments financed from the FSS budget and from funds received in the course of entrepreneurial activity);
• the categories of health workers who can receive co-payments;
• sources of funding for wage supplements (a separate fund should be created in the clinic).

Features of calculating incentive payments

Situations in which a provider deserves a financial reward include:

• high quality of work;
• the presence of achievements in the chosen field of activity;
• positive results of the work;
• duration and continuity of work experience.

If the duration of work experience and the results of work can be unambiguously characterized, then it is impossible to evaluate the effectiveness of the implementation of official duties and the quality of the work done by quantitative indicators, and therefore a special methodology was developed. In accordance with its provisions, labor efficiency can be assessed by the following indicators:

• non-observance of the rules for sanitizing premises and equipment;
• the presence of errors and inaccuracies in the compiled documents;
• the presence of patient complaints;
• the number of identified postoperative and other complications;
• the presence of cases of hospitalization carried out at the wrong time;
• admitting incorrect and inaccurate diagnoses;
• the number of diseases detected by the profile of medical activity (at early and late stages of development);
• other indicators.

The decision on the effectiveness of the work of medical workers remains with a commission specially created within the medical institution. Based on the results of assessing the activities of employees, an appraisal act is drawn up - it becomes the basis for calculating incentive surcharges. If, at the end of the year, surplus funds are found in the fund created for the payment of allowances, doctors are charged an annual bonus.

How does overlapping and substitution affect incentive payments to health workers?

If the combination of positions is prescribed in the text of the employment contract, it will not be encouraged by incentive payments.

Medical workers often work for an absent doctor, but this does not always mean that they will be entitled to a salary increase. Part-time workers can count on incentive salary increments only if the additional activity was formalized in the manner prescribed by law - an employment contract. The same applies to health workers who temporarily replace their colleagues.

For which incentive payments to health workers can be canceled

The administration of the medical institution decides who will receive a stimulating salary increase and who will remain without additional payments. At the legislative level, there are no instructions on the mandatory payment of incentive bonuses to health workers. But if in the clinic there is a Regulation on incentive payments, then there must be a reason for refusing to accrue - violation of labor discipline, lack of positive indicators in work, negligence towards patients, and so on.

If a health worker never receives incentive payments, although he works hard and does not make mistakes, you should contact the accounting department of the enterprise, demand the Order on the basis of which the salary was calculated, and look for reasons why the allowances are not made. If it turns out that the refusals to charge additional payments are not justified, you can file a complaint.

Legislative acts on the topic

	On the types of payments to employees of institutions
Resolution of the Government of the Russian Federation of 05.08.2008 No. 583	Approval of the Regulation on the establishment of wage systems for employees of federal budgetary, autonomous and state institutions
	List of factors for which material incentives are relied on
Order of the Ministry of Health of the Russian Federation of June 28, 2013 No. 421	List of performance indicators used to address employee incentive issues

Typical mistakes

Mistake: The obstetrician-gynecologist demands a stimulating salary increase for the fact that she replaced the absent doctor and temporarily performed his duties for a whole month.

In recent years, the salaries of doctors and the entire system of remuneration of medical workers have changed significantly, which can be associated with the need to motivate employees to provide quality medical care. In turn, the level of salaries of health workers should fully depend on how high-quality medical services it provides to the population.
Government Decree No. 2190-r dated November 26, 2012 provides for a phased change in the payroll system in the public sector, which implies the improvement of the main components of wages - salary, tariff (hourly) rate, as well as additional incentive and compensation payments.

At the same time, the level of salaries of health care workers should fully depend on how high-quality medical services it provides to the population.

Salaries of doctors and medical workers in 2016 *

According to Rosstat, in the first half of 2016, the average salary of doctors and medical workers was 48,946 rubles.

The highest salaries of doctors are predictably recorded in the Nenets, Chukotka, Yamalo-Nenets, Khanty-Mansi - Yugra, autonomous regions; Kamchatka Territory; Magadan, Sakhalin, Tyumen regions; Moscow and the Republic of Sakha (Yakutia).

The lowest salaries of medical workers and doctors: Oryol Region, Republic of Mari El, Ulyanovsk Region, Republic of Ingushetia, Republic of Adygea, Republic of Dagestan, Kabardino-Balkar Republic, Karachay-Cherkess Republic, Republic of North Ossetia-Alania, Republic of Kalmykia.

For the full tables of salaries of doctors in 2016 in Russia, see below.

Piecework wages of health workers

The salary of a doctor can be formed according to the principle of piecework, taking into account some peculiarities. In particular, it is necessary to take into account the recommendations of the Ministry of Health of the Russian Federation, as well as the Russian Tripartite Commission (RTK). Generally speaking, the current legislation contains provisions that allow the establishment of piecework wages in the organization, while there are no exceptions for employees of medical institutions. In the case of piecework wages for health workers, the established price for the work performed is taken into account, while the tariff rate is set for the work norm performed, and does not include incentive or compensatory payments. The fact that these concepts are not equivalent follows from the conclusions of the courts based on the results of the consideration of civil cases. In addition, the order of the Ministry of Health of the Russian Federation No. 377, which contained a direct indication of the possibility of using piece rates to establish the salaries of medical workers, also became invalid. Today, the Ministry of Health of the Russian Federation adheres to the position that the salary of doctors should include: salary, incentive payments, compensatory payments and the tariff rate. However, if in the hospital there is still a need to establish a piece-rate form of remuneration for individual employees, then it is necessary to provide for such a form in the local act of the institution - in the collective agreement or other local act. This will not constitute a violation of applicable labor laws.

Brigade forms of remuneration

Some hospitals are considering the possibility of establishing a brigade form of remuneration in the institution, that is, when the salary of a particular doctor or other medical worker depends on the overall performance of the unit, department or mobile team.

Today, the system of remuneration of medical workers in ordinary city and regional hospitals provides for the calculation of the amount of incentive surcharges depending on the specific collective results of the work of hospital employees.

The formula for calculating the optimal average daily load on the ambulance crew:

According to the author's method of V.M. Shipova and A.N. Plutnitsky, the optimal load on the ambulance team has not been determined, since the call flow is random and the frequency of calls is not regulated. But it is possible to calculate the optimal load on the ambulance crew. Based on the planned and normative data on the provision of the population with ambulance cars and the number of calls, we derive the formula:

318 X 10: 365 = 8.7, where
318 - number of calls per 1000 population;
10.0 thousand - the number of the population;
365 - calendar days of the year;
The indicator 8.7 (9.0) calls is the average daily load on the ambulance team.

The remuneration system in such institutions is fixed in local acts (agreements, collective agreements, regulations, etc.), while taking into account:

• approved classifiers of professions, positions;
• developed medical professional standards;
• views of health care professional unions;
• professional communities of employers;
• the volume of state guarantees in the field of labor remuneration;
• the position of the Russian Trilateral Commission;
• position of the Ministry of Health of the Russian Federation.

So, in the joint recommendations of the Ministry of Health of the Russian Federation and the RTK, the use of a brigade form of remuneration is not provided for. Earlier, the application of the form of brigade pay for medical workers was provided for in the order of the Ministry of Health of the USSR No. 1180 dated November 10, 1986, but since 2009 it has lost its legal force. However, the current legislation does not prohibit taking into account the results of the team's work to calculate incentive payments to a specific medical worker. Also, the Order of the Government of the Russian Federation No. 2190-r dated November 26, 2012 states that specific incentives should be established for medical workers for achieving collective results of work.

The ratio of parts of the salary

The Ministry of Health of the Russian Federation has set the maximum level of the ratio of the average salary of chief doctors of hospitals and medical workers in the system of health care institutions. Thus, in accordance with Order No. 170 of March 28, 2013, the level of the maximum salary of the chief physician of a hospital is a multiple of 8 salaries of employees of hospitals under the jurisdiction of the Ministry of Health of the Russian Federation. The regulation on remuneration of employees of the Medical Organization was developed in accordance with the requirements of the Labor Code of the Russian Federation and other regulatory legal acts containing labor law norms.

Salary of medical workers

This section discusses all the legal features of setting salaries for medical workers, including the rules for the use of professional qualification groups, accounting for length of service and the possibility of establishing an individual salary for a medical worker.

Establishment of a personal salary

The salary is a certain amount of remuneration for a medical worker, which is established for him for the performance of his professional duties, provided for by a specific position. The salary does not include other additional payments. We believe that the establishment of personal salaries for health workers of state and municipal hospitals is not expressly prohibited by labor legislation, although it is not recommended by other norms for the following reasons. In accordance with Art. 22 of the Labor Code of the Russian Federation, a medical institution, as an employer, must provide its employees with the same wages for performing similar work. At the same time, the establishment of different salaries for the same positions is not prohibited, but it seems unjustified. The RTK adopted unified recommendations on the establishment of remuneration for the work of employees of state and municipal institutions dated December 25, 2015, in which it is not recommended to establish salaries for employees who are included in the same qualification group of different rates. It is also not recommended to indicate the range of salaries for health workers who are engaged in work of the same complexity. However, as the law enforcement practice shows, nevertheless, the decision to establish an individual salary is not recognized as labor discrimination in the event that employees occupy the same position, but perform different amounts of work of varying complexity.

How to take into account the experience

As a general rule, the length of service of a medical worker does not in any way affect the size of the official salary established for him. As we have already said, the official salary is a fixed monthly payment to an employee who has performed his job duties in the proper amount. Since the salary of medical workers consists not only of the official salary, their continuous medical experience should be reflected in other payments, for example, in payments of a compensatory nature. Such recommendations are established by the order of the Ministry of Health and Social Development of the Russian Federation No. 818 dated December 29, 2007.

Application of occupational skill groups

Vocational qualification groups (VQGs) can be used when establishing base rates and salaries by the Government of the Russian Federation, the salary of medical workers of state and municipal hospitals cannot be lower than the salaries established according to the VQG. According to the decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012, the concerned executive bodies, together with the Ministry of Labor of the Russian Federation, can develop and submit their specific proposals on the official salaries of the PKG employees. The basis for the formation of the PCG is certain requirements for the level of qualifications of employees, which they need to carry out specific professional activities, since in accordance with labor legislation, the salary of a doctor, like any other employee, depends on his qualifications. Therefore, prior to the establishment of base salaries for specific positions by the Government of the Russian Federation, in health care institutions, PSCs can be used in the development of salary systems for health workers. This is confirmed by the provisions of Decree of the Government of the Russian Federation No. 583 of 08/05/2008, which states that the salaries of employees are established by the management of the institution based on the requirements for qualifications and work experience in a specific position (PCG). This takes into account the volume of work performed by employees and its complexity.

The ratio of the salaries of managers and health workers

The size of the official salaries of medical workers does not in any way affect the salary of the chief physician of the hospital and the salaries of his deputies. As stated in Art. 145 of the Labor Code of the Russian Federation, the remuneration of the heads of state and municipal institutions is established in accordance with labor legislation, the constituent documents of the official, regional and municipal acts. The specific terms of remuneration of executive officials are reflected in their employment contracts. At the same time, a number of normative acts adopted recommendations for establishing the level of remuneration for the heads of institutions: recommendations for 2016, approved by the RTK dated December 25, 2015, as well as in relation to federal institutions - RF Government Decree No. 583 dated August 5, 2008. In these documents, it is recommended to establish a salary for the heads of the institution that is a multiple of 8 of the average salaries of all employees of the institution; in the decision of the RTK of December 25, 2015, it is also recommended to set salaries for chief accountants and deputy chief physicians at the level of 70-90% of the salaries of hospital managers.

Salary: control of establishment

Which bodies can check the correctness of the choice of the official salary for employees of a medical institution:

labor inspection during inspections within the framework of state supervision over the observance by a medical institution of the labor legislation of the Russian Federation. In addition, the state labor inspectorate checks the implementation of the program for improving the remuneration system in state and municipal institutions, which was approved by the order of the Government of the Russian Federation No. 2190-r dated November 26, 2012;
The Ministry of Health of the Russian Federation, as a department that exercises the powers of the founder in relation to subordinate medical institutions; territorial compulsory medical insurance funds, which check the salary amounts as part of inspections of labor costs, which are included in the structure of the tariff for paying for medical care in the compulsory medical insurance system;
other government agencies authorized to audit the financial and economic activities of the hospital.
The reporting form on the wages of employees of medical organizations in the field of compulsory health insurance was approved by Order of the FFOMS dated March 26, 2013 No. 65.

Calculation of the amount of funds allocated for the remuneration of employees of the cabinet (office) of general medical practice (family doctor)

1. Staff number of employees

2. The number of attached population, people.

3. Funding per capita, rubles.

4. Amount of financing, rub.

5. Statement of expenditure of funds

Chief physician

Chief Accountant

Compensation payments to medical workers

Indication of compensation payments in the employment contract

Is it possible to prescribe in the labor contract of a medical worker that the amount of his compensation payments is established by the legislation of the Russian Federation? In the event that the legislator has established the minimum size of compensation payments for medical workers, the employer must indicate in the employee's employment contract in a specific amount or as a percentage of the official salary. Compensation payments to medical workers can be provided for various reasons: for medical experience, for irregular working hours, for work in rural areas, for the presence of a professional category, etc. Labor legislation, as a rule, sets only the minimum amount of such payments. The employer should establish the specific amounts of compensation allowances for medical workers, having prescribed such sections in the regulation on the remuneration of the hospital. Additional guarantees for employees who work in conditions deviating from normal must be spelled out in the employee's employment contract, in accordance with Art. 57 of the Labor Code of the Russian Federation. In addition, the recommendations approved by order of the Ministry of Health of the Russian Federation No. 167-n dated 04/26/2013 indicate that specific factors and conditions for receiving all compensation payments should be prescribed in the regulation on remuneration, as well as in the employee's employment contract.

Reducing the size of compensation payments based on the results of the SAUT

Let us consider the conditions under which a health worker can be reduced the compensation payments provided to him in connection with a special assessment of working conditions (SAWC). The amount of compensation for a health worker may change with an improvement in his working conditions, which is confirmed by the conclusion of a specialist on SUT, carried out in a hospital (Article 74 of the Labor Code of the Russian Federation); As you know, guarantees and compensations for medical workers who are employed in working conditions deviating from normal are provided in accordance with the provisions of labor legislation, the collective agreement of the hospital, with the employee's labor agreement, etc.

However, the employer must cancel the guarantees provided earlier in the event that safe working conditions are provided at the employee's workplace, which is confirmed by the conclusion of the state examination or SOUT. In connection with the adoption of the new law No. 426 "On SOUT", there is a transition period to a new system for assessing jobs. So, if the attestation of workplaces was carried out in the hospital before July 13, 2015, then it will continue to operate for 5 years. SOUT during this period is not necessary. The medical institution has the right, but not the obligation, to initiate the SAWS before the expiration of the validity of the certification results.

If the preservation of working conditions, which gave the employer the right to establish compensation payments to their employees, was confirmed, then the amount of these additional guarantees cannot be changed in comparison with those payments. Which were in effect at the beginning of 2014. In accordance with the clarifications of the Ministry of Labor of the Russian Federation of 12/15/2014 regarding the application of the new rules of the SAUT, the improvement of working conditions is to reduce the final class or subclass of working conditions at a specific place of work of an employee. So, if the working conditions of the medical worker have improved, which was confirmed in the conclusion of the SAUT, the hospital management may reconsider the amount of compensation that is provided to the employee in harmful working conditions. In this case, it is necessary to remember the rules for changing the terms of the employment contract between the hospital and the employee, which are set out in detail in Art. 74 of the Labor Code of the Russian Federation.

Replacement of additional leave for harm with monetary compensation

Many workers have a desire to replace part of their annual leave with monetary compensation. Is it possible from the point of view of the law to replace the leave provided to an employee for work in harmful working conditions with monetary compensation?

Replacing vacation with compensation is possible, but it is important to comply with a number of conditions:

• you can only compensate for a part of the vacation "for harmfulness" (2, 3, 4 degrees);
• all employees of the Labor Code of the Russian Federation are guaranteed a minimum of 7 calendar days for work in harmful and dangerous working conditions;
• if the collective agreement of the medical institution or industry acts guarantee such employees more than 7 days of additional leave, then, at the employee's request, the part exceeding the guaranteed one can be replaced with monetary compensation;
• the possibility of replacing parts of vacation days with the provision of monetary compensation should be expressly stipulated in the hospital's local acts or industry agreement;
• the employee must express his desire to replace the additional vacation with money, his consent is formalized by an additional agreement to the employment contract.

Accounting for compensation payments when on duty at home

Remuneration for medical workers consists of a salary, compensation and incentive payments. Taking into account all these payments, payment for the doctor's duty at home is also carried out.

Home duty refers to the stay of a hospital doctor at home, awaiting a call to a medical institution or to a patient to provide him with urgent or emergency medical care. For such employees, special working hours and time tracking are usually established.

In accordance with the order of the Ministry of Health of the Russian Federation No. 148-n dated 04/02/2014, the time during which the medical worker was on duty at home is a worker, and it is taken into account in the summarized accounting of working time.

At the same time, the legislation does not establish specific rules for calculating doctor's salary who was on duty at home. This means that all payments to the employee are taken into account in a general manner, including compensation payments, regardless of whether the doctor was on duty at home or not.

Compensation payments: control of establishment

The following government agencies and officials can verify the correctness of the establishment of compensation payments for medical workers:

territorial bodies of the labor and employment service, in the course of the state examination of working conditions. It is during such a check that the inspectors assess the correctness of providing medical workers with the required amount of compensation for work with harmful or dangerous working conditions;

the state labor inspectorate, which assesses the safety of working conditions, checks the provision and protection of the labor rights of medical workers during special inspections;

labor protection specialists and inspectors of trade union bodies of medical workers who carry out an independent examination of the working conditions and safety of employees in the workplace;

territorial bodies of the compulsory medical insurance, in the course of inspections, the purpose of which is to check the costs of wages, which is part of the tariff for paying for medical care.

Incentive payments to health workers

Using scoring

Medical institutions of the municipal or state health care system are not obliged to use the score of work performance to assess the performance of their employees. Incentive payments to medical workers should be established in local hospital regulations, in a collective agreement, industry agreement or other regulations that contain labor standards.

By order of the Ministry of Health of the Russian Federation No. 421 of June 28, 2013, methodological recommendations were approved, which state that there are different mechanisms for distributing the fund of incentive supplements between employees of a particular institution. Including the introduction of a scoring system, bonuses is permissible. This means that a specific medical institution can develop and implement its own mechanisms for calculating incentive co-payments for medical workers, including it has the right to introduce a point-based system for distributing payments. For this, it is necessary to develop appropriate criteria and indicators.

Payments to PNP "Health"

Payments to medical workers within the framework of the national project "Health" are established in the regions in accordance with tariff agreements and the terms of the territorial program. Recall that one of the objectives of the program is to provide financial incentives for medical workers. Should the management of the medical institution keep the payments to district doctors and nurses that were previously provided to them under this program? Labor legislation in art. 135 of the Labor Code of the Russian Federation identifies sources in which additional incentive payments to employees can be established, including the conditions for the payment of bonuses.

In accordance with the program of state guarantees for 2016, which was approved by Decree of the Government of the Russian Federation No. 1382 of December 19, 2015, the structure of the tariff provided for paying for the assistance provided to the population in the compulsory medical insurance system includes incentive payments for district doctors, nurses, paramedics and midwives points, ambulance staff, etc.

Tariff agreements between the regional executive body, the territorial CHI fund, medical workers' trade unions, as well as medical non-profit organizations establish specific tariffs for payment of medical care provided by hospitals.

Today, when setting these tariffs, the commission authorized by the participants takes into account the amount of incentive additional payments to medical workers, which were previously established by the national program "Health".

In this regard, we believe that a medical institution should provide that all such payments should be made in an amount that is already taken into account in the tariff for the provision of medical care under the territorial compulsory medical insurance program, approved at the regional level.

Conditions under which incentive payments are not made

A medical institution must initially prescribe special conditions in the regulatory documentation, upon the occurrence of which incentive additional payments to specific health workers will not be made. The current system of remuneration for medical workers is established in the collective agreement of the hospital, in the regulation on remuneration, as well as in the employment contracts of specific employees. From the legal essence of incentive payments, it follows that their accrual to specific medical workers is not the responsibility of a medical institution - this is its right. At the same time, the order of the Government of the Russian Federation No. 2190-r of 11/26/2012 explicitly states that the remuneration system, as well as the conditions for obtaining certain payments and remuneration, should not be interpreted by the parties in an ambiguous manner, they should be equally understandable as a health worker and the employer.

• if during the inspections it was revealed that the provision of medical services to citizens was paid, while the program of state guarantees provides for the provision of such services free of charge;
• the imposition of a disciplinary sanction on a medical worker.

At the same time, the remuneration system for a specific medical institution may provide for other conditions for depriving a medical worker of incentive payments in a specific period.

Depreciation of medical workers

A controversial issue is the application of such a sanction as depreciation to medical workers. Note that, according to departmental recommendations, as well as the provisions of the Labor Code of the Russian Federation, it is recommended that medical institutions provide conditions for the use of incentive surcharges, but not conditions for depriving the employee of the bonus. In accordance with Government Decree No. 2190-r, measures to improve the system of incentive supplements to medical workers are carried out with the aim of correlating the size of doctors' salaries with specific results of their work. First of all, the quality of the provided medical services is taken into account, on the basis of which these or those incentive payments are applied. The bonus itself is one of the types of incentive supplements for medical workers, therefore, the medical institution must establish specific conditions for its receipt. A specific list of disciplinary punishments is contained in Art. 192 of the Labor Code of the Russian Federation, however, such a measure as deprivation of bonuses (deprivation of bonuses) is not contained in the current version of the code. This is evidenced by the judicial practice. The courts unequivocally interpret the application of deprivation in relation to any employee of the employer as an unreasonable and unapplicable sanction, which is recognized as illegal by the current legislation. In this regard, we recommend that the chief doctors of hospitals avoid the application of such sanctions in relation to medical workers; in the local acts of the hospital, all the more, there should not be any conditions for deprivation.

Labor standards for incentive payments

When establishing incentive payments to health workers, certain labor standards are used, however, not all of them are advisable to be used as criteria for additional payments. In particular, labor standards that are not directly provided for the purpose of assigning incentive payments and do not in any way reflect the results of the professional activity of the health worker and the quality of the medical services provided to him are inapplicable. This is due to the provisions of the order of the Government of the Russian Federation No. 2190-r dated November 26, 2012, which states that all incentive additional payments for employees depend on the quality of their work and the professional results achieved, and specific indicators and criteria for their activities should be reflected in the employee's employment contract based on the developed wage system. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, the specific labor standards of the institution are established by the labor rationing system in the organization. At the same time, different norms and standards can be established in a medical institution: in terms of the number of personnel, in terms of time, in terms of volumes, production, etc.

It is inappropriate to use the following norms to determine incentive payments:

1. The norm of the number of health workers. In accordance with the order of the Ministry of Labor of the Russian Federation No. 504 of September 30, 2013, this norm is needed, first of all, to determine the number of employees of certain positions that are necessary to perform a certain amount of work or production and other functions. For example, such a rate may be expressed in one medical position per district, in accordance with the number of the attached population.

2. Standards of time. In accordance with the order of the Ministry of Labor No. 504, they express the specific time spent by a health worker, which he needs to provide one service (work). This indicator is primarily used to calculate the norms for the number of employees.

Service standards, in accordance with the order of the Ministry of Labor of the Russian Federation No. 504, are indicators of the number of jobs, equipment, production areas, etc., with which an employee works during a certain unit of working time. Such an indicator can be used to assess the performance of an employee when calculating incentive payments.

An approximate list of indicators for the appointment of incentive payments for the intensity and performance of work, as well as bonus payments for certain categories of workers, is recommended by the expert group of the information center "MCFER-Medicine".

Salary fund for medical workers

In medical institutions, there are several sources for the formation of the salary fund for medical personnel:

• funds from budgets of different levels;
• funds from non-budgetary sources (from the CHI funds);
• cash received from income-generating activities.

In health care institutions that are under the jurisdiction of the region or municipality, the wage fund is formed in accordance with the relevant regulations of the constituent entity of the Russian Federation or the municipality. In accordance with the order of the Government of the Russian Federation No. 2190-r of 11/26/212, a system of differentiated remuneration of personnel is currently envisaged, the final salary of a doctor depends on the complexity of the work performed by him, its volume, as well as the qualifications of the employee. The procedure for determining the salary fund of medical workers of a particular unit should be approved in the local acts of the medical institution, which establish the organization's remuneration system. In this case, the wage fund is calculated in different ways. So, in some hospitals, the staffing table is taken as a basis, in others, the amount of annual funding is taken into account.

In any case, the remuneration of medical workers has a basis - salary, which indicated in the employment contracts. It is in relation to the size of the salary that other compulsory payments are applied - compensatory... The procedure for their accrual must be spelled out in the local acts of the hospital.

The accrual incentive payments depends on the quality indicators and volume of work performed in the hospital, as well as on other conditions described in the regulation on remuneration. It is from these components that the modern differentiated system of remuneration is formed. Thus, the final salary of a doctor directly depends on the quality, complexity and volume of his work, i.e. on the quality of medical services provided to the population.

In order to calculate the incentive part of earnings using such a system, you must follow the following order:

• determine how many points each doctor earned during the reporting period;
• summarize all points earned by employees of the department;
• determine the part of the wage fund, which falls on incentive payments to employees of the department;
• calculate the cost of one point;
• calculate the incentive part of the employee's salary, based on the cost and the amount of points earned.

Based on this, the salary fund for a medical worker is the sum of all payments due to an employee for a month worked, including incentive payments, bonuses, and other regular payments. The salary of a doctor is calculated based on the tariff lists of the hospital, as well as its approved staffing table.

*) includes doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education, providing medical services (ensuring the provision of medical services) in educational, scientific, cultural, health care, social services.

In order to encourage medical workers in the Russian Federation, since 2014, a program has been in place to support citizens employed in this area. In particular, such support consists in obtaining incentive payments, the appointment of which is carried out based on the criteria specified in the governing laws and regulations. In addition, incentive payments to health workers in 2020, as before, are designed to attract more specialists to work in government agencies, since they are charged exclusively in non-profit organizations.

Legislative acts regulating the assignment of additional payments

On what basis can a healthcare professional qualify for an Intensity and Performance Benefit? Amounts additional to the basic salary are calculated on the basis of the following laws and regulations.

Who can't get incentive co-payments?

The provision on incentive payments in health care clearly limits the range of workers who can qualify for material supplements to their basic income as wages. An obligatory factor that makes it possible to accrue both permanent and one-time payments is that a medical worker has a certificate in the main specialty - this provision is spelled out in the RF PP No. 583, and other factors (merits in work, etc.) cannot be canceled. can.

In addition, the appointment of payments is possible to certain categories of doctors and medical workers, taking into account the existing restrictions. Thus, such additional payments are not entitled to the following categories of employees employed in the health care sector.

• Those persons who belong to the administration of medical institutions. In some cases, receiving copayments is allowed, but only on condition that the employee, in addition to performing the main function, is also a practicing doctor.
• Medical workers who provide assistance that is classified as high-tech according to the appropriate classification.
• Those employees who are members of the Health program operating in the Russian Federation. Participation in it includes providing assistance in delivering childbirth, caring for newborns, providing medical services as a pediatrician or family doctor, etc.

The principle of remuneration of medical workers

Speaking of incentive charges, it is worth considering in more detail the types of remuneration that are relevant to employees in the medical field.

Based on the Labor Code of the Russian Federation, employees of medical institutions are entitled to the following types of charges.

• Basic, or basic, which are calculated based on the size of the salary and the specifics of the type of activity.
• Compensatory... Their accrual is regulated by norms that differ depending on the region in which the employee works.
• Social... They can be assigned based on the health worker's affiliation with one of the groups on the list of recipients of social benefits.
• Stimulating- appointed as a result of the analysis of activities and the performance of direct duties by a doctor or other health worker.

It is worth noting that if all other charges, except incentives, are strictly controlled by federal or regional regulations, then incentives can be regulated directly by the management of the medical institution. To carry out such an action, the administration of each individual institution is obliged to issue a document - a resolution (created, of course, on the basis of the general law on payments and not contradicting its provisions). This document defines the nuances of the appointment of payments that can be applied directly to the employees of this organization. Each of the employees belonging to the category of persons that can qualify for such payments has the right to familiarize themselves with this document.

What are incentive co-payments? These are monetary charges assigned on a monthly basis based on accepted criteria for evaluating the work of doctors and medical personnel. In the event that a specific institution at the end of the calendar year remains an unused part of the funds allocated exclusively for receiving incentive supplements, it is allowed to receive one-time payments, which will be assigned based on the results of work for the current year.

The amount of incentive charges

It is worth noting that the amount of incentive co-payments is not constant - it directly depends on the amount of services related to the performance of direct duties, made by the medical officer.

The following rules apply to the amount of charges on the territory of the Russian Federation.

• Payment of a cash bonus of a stimulating nature is made on the basis of a separate order from the administration of the institution.
• The order is issued every month.
• The amount of payments is established by the administration of the medical institution, taking into account the permissible minimum and maximum values ​​established by legislative acts.

Basis for the assignment of co-payments and principles of assessment

The following factors have a decisive influence on the amount of the accrued additional payment.

• The time that a specific employee worked during the month for which the payment is calculated.
• Compliance with the health worker standards for the provision of first aid to the population.
• Efficiency in the performance of work duties.
• The length of service of the employee and its continuity.

Without fail, the administration, when assigning payments, must be guided by the current provisions on remuneration, as well as federal, regional acts and presidential decrees affecting the procedure for calculating and receiving such amounts.

Document's name:
Document Number:	204/13
Type of document:
Host body:
Status:	Acting
Published:
Date of adoption:	03 April 2018
Effective date:	20 april 2018
Revision date:	25 march 2020

On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities ...

GOVERNMENT OF THE MOSCOW REGION

RESOLUTION

On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

Document with changes made:
(Official website of the Government of the Moscow Region www.mosreg.ru, 26.06.2019);
(Official website of the Government of the Moscow Region www.mosreg.ru, 03/25/2020).
____________________________________________________________________

______________
* Name as amended by the Decree of the Government of the Moscow Region dated June 25, 2019 N 375/19 by the Decree of the Moscow Region Government dated March 25, 2020 N 140/7.

In accordance with Appendix No. 8 "Rules for the provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation for one-time compensation payments to medical workers (doctors, paramedics) who have arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements , or a city with a population of up to 50 thousand people "to the state program of the Russian Federation" Development of health care ", approved by the Government of the Russian Federation of December 26, 2017 N 1640" On approval of the state program of the Russian Federation "Development of health care", the Government of the Moscow region
(Preamble as amended by Decree of the Moscow Region Government dated June 25, 2019 N 375/19; as amended on March 26, 2020 by Decree of the Moscow Region Government dated March 25, 2020 N 140 / 7.

decides:

1. To approve the attached Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people.

2. Establish an expenditure obligation of the Moscow Region related to the implementation of measures to financially support one-time compensation payments to medical workers (doctors, paramedics) who have arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with population up to 50 thousand people.
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

3. Determine the Ministry of Health of the Moscow Region as an authorized central executive body of state power of the Moscow Region to provide lump-sum compensation payments to medical workers.

4. Financial provision of one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people, is carried out on the basis of co-financing at the expense of subsidy funds provided within the budgetary allocations provided for by the Law of the Moscow Region for the next financial year and planning period.
(Clause as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

5. The Main Directorate for Information Policy of the Moscow Region shall ensure the official publication of this resolution in the newspaper "Daily News. Moscow Region", "Information Bulletin of the Government of the Moscow Region", placement (publication) on the website of the Government of the Moscow Region in the Internet portal of the Government of the Moscow Region and on " The official Internet portal of legal information "(www.pravo.gov.ru).

6. Control over the implementation of this resolution shall be entrusted to the first Vice-Governor of the Moscow Region, IN Gabdrakhmanov.
(Clause as amended, entered into force on July 7, 2019 by the decree of the Government of the Moscow Region of June 25, 2019 N 375/19.

The governor

Moscow region

A.Yu. Vorobiev

The procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to ...

APPROVED BY

government decree

Moscow region

dated April 3, 2018 N 204/13
(As amended by
from July 7, 2019 by the decree
Moscow Region Government
dated June 25, 2019 N 375/19. -
See previous edition)

The procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people *

______________
* The name as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7 ..

1. This Procedure regulates the provision of one-time compensation payments to medical workers (doctors, paramedics) who are citizens of the Russian Federation who do not have unfulfilled obligations under the contract on targeted training (with the exception of medical organizations with a staffing of less than 60 percent) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people and who have concluded an employment contract with a medical organization subordinate to the Ministry of Health of the Moscow Region, on a full-time basis with a working time established in accordance with with article 350 of the Labor Code of the Russian Federation, with the performance of a labor function in a position included in the list of vacant positions of medical workers in medical organizations and their structural subdivisions, upon replacement of which, one-time Compensation payments for the next financial year (hereinafter, respectively - a lump sum compensation payment, medical workers), as well as medical workers who have fulfilled the obligations related to targeted training (targeted training), provided that they continue to work in the same medical organization located in a rural population point, or a workers' settlement, or an urban-type settlement, or a city with a population of up to 50 thousand people.
(Clause as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

2. The size of the lump sum compensation payment is 1 million rubles. for doctors and 0.5 million rubles. for paramedics.

3. A one-time compensation payment is provided to a medical worker once.

4. The Ministry of Health of the Moscow Region (hereinafter referred to as the Ministry) has the right to make a decision on providing a medical worker with a one-time compensation payment if he has obligations related to targeted training (targeted training), subject to the conclusion of an employment contract with a medical organization subordinate to the Ministry (hereinafter - a medical organization), the staffing of which is less than 60 percent.

5. The Ministry annually, before November 1 of the year preceding the next financial year, approves the List of vacant positions of medical workers in medical organizations and their structural units, upon replacement of which, one-time compensation payments are made for the next financial year (hereinafter - the program register of positions).

6. A lump sum compensation payment is provided on the basis of an agreement on the provision of a lump sum compensation payment (hereinafter referred to as the contract) concluded between a medical worker, a medical organization and the Ministry.

7. The form of the contract is approved by the Ministry.

8. Copies of the following documents are attached to the agreement:

passports of a citizen of the Russian Federation;

insurance certificate of state pension insurance;

certificates of registration of an individual with a tax authority;

a document on graduation from an educational institution of higher education (doctors) or a professional educational organization (paramedics);
Decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

document on the end of the internship or residency (for doctors of specialties, training for which in internship or residency is mandatory for the implementation of labor activities in accordance with the Order of the Ministry of Health of the Russian Federation of 08.10.2015 N 707n "On approval of qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health and Medical Sciences");
(The paragraph as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

a document on professional retraining (if any);

specialist certificate (or specialist accreditation certificate);

certificates of recognition of foreign education and (or) foreign qualifications;

a certificate of a specialist issued by the Federal Service for Surveillance in Healthcare of Roszdravnadzor, or by its territorial bodies (for persons who received medical training at universities of foreign countries who are citizens of the Russian Federation);

labor contract;

a work record book or information about work activity received in a multifunctional center for the provision of state and municipal services in hard copy;
(The paragraph as amended, entered into force on March 26, 2020 by the decree of the Government of the Moscow Region of March 25, 2020 N 140/7.

order of appointment to the position;

a document from a credit institution containing the name of the bank, BIK of the bank, TIN of the bank, KPP of the bank, personal account of a medical worker;

licenses for the implementation of medical activities by a healthcare institution.

9. The contract is concluded on the basis of an appeal of a medical worker to the head of a medical organization, received after the conclusion of an employment contract that provides for work in a position included in the program register of positions, and the end of the probationary period, if such a period is set for a medical worker when hiring.

10. The contract signed by the medical worker and the head of the medical organization is sent by the medical organization to the Ministry.

11. The Ministry, within a period of not more than 30 working days from the date of receipt of an agreement on the provision of a lump sum compensation payment, signed by a medical worker and the head of a medical organization, signs the specified agreement and sends two copies of the agreement on the provision of a one-time compensation payment to the medical organization.

12. If there are grounds for refusing to conclude an agreement provided for in paragraph 13 of this Procedure, the Ministry, within the time period specified in paragraph 11 of this Procedure, sends a reasoned refusal to conclude an agreement on the provision of a lump-sum compensation payment to the medical worker.

13. Grounds for refusal to conclude an agreement are:

non-compliance of the medical worker who signed the contract with the requirements provided for in paragraph 1 of this Procedure;

sending to the Ministry of the agreement that does not correspond to the form of the agreement approved by the Ministry;

lack of copies of the documents provided for in paragraph 8 of this Procedure.

14. When eliminating the reasons that served as the grounds for refusing to conclude an agreement, the medical worker has the right to reapply for a one-time compensation payment in accordance with paragraphs 9 and 10 of this Procedure.

15. Ministry:

keeps records of concluded and executed contracts;

transfers the lump-sum compensation payment to the account of the recipient of the lump-sum compensation payment.

16. A medical worker who has concluded an agreement with a medical organization and the Ministry undertakes the following obligations:

1) perform labor duties for 5 years from the date of conclusion of the contract for positions in accordance with the labor contract, subject to the extension of the contract for the period of non-fulfillment of the labor function in full (except for the time of rest provided for and 107 of the Labor Code of the Russian Federation);

2) return to the budget of the Moscow Region part of the lump-sum compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract to the expiration of the 5-year period (except for cases of termination of the employment contract on the grounds provided for in paragraph 8 of part one of Article 77 and paragraphs 5-7 of part the first article 83 of the Labor Code of the Russian Federation), as well as in the case of transfer to another position or admission to training in additional professional programs;

3) return to the budget of the Moscow Region a part of the lump-sum compensation payment calculated in proportion to the unworked period from the date of termination of the employment contract, in case of dismissal due to conscription (in accordance with paragraph 1 of part one of Article 83 of the Labor Code of the Russian Federation) or extend the period validity of the contract for the period of non-fulfillment of functional duties (at the choice of the medical worker).

Document revision taking into account
changes and additions prepared
JSC "Codex"

On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)

Document's name:	On approval of the Procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (as amended on March 25, 2020 of the year)
Document Number:	204/13
Type of document:	Decree of the Government of the Moscow Region
Host body:	Moscow Region Government
Status:	Acting
Published:	Official website of the Government of the Moscow Region www.mosreg.ru, 09.04.2018
Date of adoption:	03 April 2018
Effective date:	20 april 2018
Revision date:	25 march 2020