Current state of the labor system in healthcare

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Abstract

The publication presents an analysis of the modern regulatory framework for labor, shows controversial positions on each component of the labor rationing system in healthcare. The amount of normative time spent on visits to outpatient doctors, established by orders of the Ministry of Health of Russia, in the main medical specialties: doctors-the¬rapists district, pediatricians district and general practitioners (family doctors), does not coincide with the data of the territorial program. Approved more than 20 years ago and currently in force standards for laboratory and instrumental examinations do not correspond to the modern equipment of medical organizations. The numbers of health workers providing primary health care to the population, established by the orders on Procedures and Regulations, for the majority of medical personnel have different meanings in the simultaneously valid regulatory documents for the provision of medical care to both adults and children. The planned and normative volume of work on outpatient care has not been reported since 2013, either in visits or in appeals about diseases. The planned and normative indicators for the amount of hospital care are characterized by sharp annual changes that are not justified ¬either by the morbidity of the population or by the technologies of the medical process, do not correspond to the actual development of the bed stock and are not reflected by healthcare practice. Based on the analysis of time standards, norms of number and planned volume of work, the authors make a reasonable conclusion about serious problems in the system of labor rationing in healthcare. The authors identified the necessary measures for its restoration and revision of the entire labor regulatory framework, which are the need to include labor rationing issues in the program of diploma and postgraduate training of doctors in a healthcare organization; advanced training of developers of staff standards and specialists approving these documents; mandatory expert assessment of documents on labor standards prior to their approval by qualified specialists on labor standardization in health care.

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About the authors

R U Khabriev

Semashko National Research Institute of Public Health

Email: mdudoc@mail.ru
Russian Federation, Moscow, Russia

V M Shipova

Semashko National Research Institute of Public Health

Email: mdudoc@mail.ru
Russian Federation, Moscow, Russia

E A Berseneva

Semashko National Research Institute of Public Health

Email: mdudoc@mail.ru
Russian Federation, Moscow, Russia

D Y Mikhaylov

Semashko National Research Institute of Public Health

Author for correspondence.
Email: mdudoc@mail.ru
Russian Federation, Moscow, Russia

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Supplementary files

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1. JATS XML
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2. Рис. 1. Составляющие системы нормирования труда

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3. Рис. 2. Численность взрослого населения (тыс.) на одну должность врача

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4. Рис. 3. Нормативная численность должностей по приказу №92н и по соответствующим приказам о Порядках (число должностей на 10,0 тыс. детского населения)

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5. Рис. 4. Нормативное число должностей медицинских сестёр на 1 должность врача по Положению и по Порядкам

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6. Рис. 5. Динамика планово-нормативного и фактического числа коек по психиатрии-наркологии (на 10,0 тыс. населения)

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© 2020 Khabriev R.U., Shipova V.M., Berseneva E.A., Mikhaylov D.Y.

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