Current state of the labor system in healthcare

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


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.

Full Text

Restricted Access

About the authors

R U Khabriev

Semashko National Research Institute of Public Health


Russian Federation, Moscow, Russia

V M Shipova

Semashko National Research Institute of Public Health


Russian Federation, Moscow, Russia

E A Berseneva

Semashko National Research Institute of Public Health


Russian Federation, Moscow, Russia

D Y Mikhaylov

Semashko National Research Institute of Public Health

Author for correspondence.

Russian Federation, Moscow, Russia


  1. Korchagin V.P. Finansovoe obespechenie zdravookhraneniya. (Financial security of health care.) M.: Epidavr. 1997; 272 р. (In Russ.)
  2. Kravchenko N.A., Polyakov I.V. Nauchnoe obosnovanie metodologii prognozirovaniya resursnogo obespecheniya zdravookhraneniya Rossii (istoriya i sovremennost'). (Scientific justification of the methodology for forecas­ting the resource provision of healthcare in Russia (history and modernity).) M.: Federal'nyy fond OMS. 1998; 392 р. (In Russ.)
  3. Ekonomika zdravookhraneniya. Uchebnoe posobie. (Health economics. Tutorial.) Ed. I.M. Sheyman. M.: THEIS. 2001; 324 р. (In Russ.)
  4. Shamshurina N.G. Ekonomika lechebno-profilakticheskogo uchrezhdeniya. (Economics of a medical and preventive institution.) M.: MTsFER. 2001; 278 р. (In Russ.)
  5. Gabueva L.A. Ekonomika LPU: ekonomi­cheskaya effektivnost' i biznes planirovanie. Biblioteka ekonomista uchrezhdeniya zdravookhraneniya. (LPU eco­nomy: economic efficiency and business planning. Library of the Economist of the Health Care Institution.) M.: Grant". 2001; 272 р. (In Russ.)
  6. Shchepin O.P., Men'shikov V.V. Stoimost' laboratornogo analiza. Metodika rascheta. (Cost of laboratory analysis. Calculation method.) M.: TOO “Labinform”. 1994; 60 р. (In Russ.)
  7. Kadyrov F.N. Tsenoobrazovanie meditsinskikh i servisnykh uslug uchrezhdeniya zdra-vookhraneniya. (Pricing of medical and service services of health care institutions.) M.: Grant". 2001; 424 р. (In Russ.)
  8. Shamshurina N.G. Tarifnaya politika v zdravookhranenii. (Tariff policy in healthcare.) M.: MTsFER. 2005; 360 р. (In Russ.)
  9. Kadyrov F.N. Ekonomicheskie metody otsenki effektivnosti deyatel'nosti meditsinskikh organizatsiy. (Economic methods of assessing the effectiveness of medical organizations.) M.: ID “Menedzher zdravookhraneniya”. 2007; 458 р. (In Russ.)
  10. Son I.M., Shipova V.M., Ivanova M.A. et al. Rationing the work of outpatient doctors in the provision of primary medical care. Zdravookhranenie. 2014; (7): 76–85. (In Russ.)
  11. Gabueva L.A. Predprinimatel'skaya deyatel'nost' uchrezhdeniy zdravookhraneniya. (Business acti­vities of health-care institutions.) M.: Grant". 2002; 944 р. (In Russ.)
  12. Order of Ministry of labour of Russia from 31.05.2013 No. 235 “About claim of methodical re­commendations for federal executive bodies on development of model branch norms of labour”. (access date: 30.07.2020). (In Russ.)
  13. Order of Ministry of labour of Russia from 30.09.2013 No. 504 “About claim of methodical recommendations on development of the systems of setting of norms of labour in public (municipal) institutions”. (access date: 30.07.2020). (In Russ.)
  14. Rogo­voy M.A. Opyt izucheniya truda meditsinskikh rabotnikov. (Experience in studying the work of medical workers.) M.: Meditsina. 1971; 108 р. (In Russ.)
  15. Shipova V.M., Minin O.G. Planned and normative indicators for outpatient care for 2013. Zamestitel' glavnogo vracha. 2013; (3): 14–22. (In Russ.)
  16. Shipova V.M. Introduction of new visiting time standards: problems and solutions. Zamestitel' glavnogo vracha. 2015; (11): 18–28. (In Russ.)
  17. Rogo­voy M.A. Izuchenie zatrat rabochego vremeni rabotnikov uchrezhdeniy zdravo-okhraneniya v tselyakh normirovaniya. (Study of working hours of health care personnel for rationing purposes.) M.: Meditsina. 1979; 83 р. (In Russ.)
  18. The order of the Russian Ministry of Health of 02.06.2015 No. 290n “About the approval of the standard branch norms of time for performance of work connected with visit by one patient of the pediatrician of the district police officer, therapist of the district police officer, gene­ral practitioner (family doctor), the neurologist, the otorhinolaryngologist, the ophthalmologist and the doctor — the obstetrician-gynecologist”. (access date: 30.07.2020). (In Russ.)
  19. Order of the Ministry of Health of Russia dated 19.12.2016 No. 973n “On approval of standard time standards for the performance of work related to the visit of one patient to a cardiologist, endocrinologist, dentist-therapist”. (access date: 01.08.2020). (In Russ.)
  20. Yurkin Yu.Yu. Development of labor standards for doctors of ultrasound diagnostics. Byulleten' GU NII obshchestvennogo zdorov'ya RAMN. 2006; 99–102. (In Russ.)
  21. Shipova V.M. Current state of activity planning and labor rationing of me­dical workers providing primary health care in outpatient conditions. Zamestitel' glavnogo vracha. 2014; (7): 25–35. (In Russ.)
  22. Plutnitskaya G.N., Bulokhov M.M., Tchikineva L.M. The application of settlement time standards related to the execution of the clinical laboratory examination. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny. 2008; (6): 37–39. (In Russ.)
  23. Plutnitskiy A.N., Zagoruiytchenko A.A. The development of activity of supporting curative diagnostic service. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny. 2013; (3): 37–39. (In Russ.)
  24. Shipova V.M., Berseneva E.A., Kirillov K.V., Kudentsova E.A. Labor standards of laboratory medical wor­kers. Spravochnik zaveduyushchego KDL. 2019; (1): 58–67. (In Russ.)
  25. Blinov N.N. Radiation diagnostic equipment in 2001. Radiologiya-praktika. 2001; (3): 52–56. (In Russ.)
  26. Order of the Ministry of Health of the Russian Federation dated 25.12.1997 No. 380 “On the state and measures to improve laboratory support for the diagnosis and treatment of patients in healthcare institutions of the Russian Federation”. (access date: 01.08.2020). (In Russ.)
  27. Letter of the Ministry of Health of the Russian Federation dated 31.08.2000 No. 2510/9736-32 “On rationing the work of specialists in X-ray rooms”. (access date: 01.08.2020). (In Russ.)
  28. The order of the Ministry of Health and Social Development of the Russian Federation of 15.05.2012 No. 543n “The Provision on the organization of rendering primary health care to adult population” (with changes and additions). (access date: 02.08.2020). (In Russ.)
  29. Order of the Ministry of Health of Russia dated 07.03.2018 No. 92n “On the approval of the Regulation on the coordination of the provision of primary health care to children”. (access date: 02.08.2020). (In Russ.)
  30. Shchepin O.P., Medik V.A. Zdorov'e naseleniya regiona i prioritety zdravookhraneniya. (Health in the region and health priorities.) M.: ­GEOTAR-Media. 2010; 384 р. (In Russ.)
  31. Plutnitskiy A.N., Zago­ruychenko A.A. Analysis of human resources in increa­sing availability and quality of medical aid in rural areas. Menedzhment kachestva v sfere zdravookhraneniya i sotsial'nogo razvitiya. 2012; (3): 40–42. (In Russ.)
  32. Plutnitskiy A.N. The improvement of manpower support of municipal hospitals. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny. 2013; (1): 38–41. (In Russ.)
  33. Udovichenko O.V. Challenges of providing specialized outpatient care for patients with diabetes mellitus and lower extremity involvement. Profilakticheskaya meditsina. 2016; 19 (4): 23–27. (In Russ.)
  34. The order of the Russian Ministry of Health of 19.03.2020 No. 198n “About a temporary order of the organization of work of the medical organizations for implementation of measures for prevention and reduction of risk of spread of new coronavirus infection (COVID-19)” (appendix No. 10). (access date: 02.08.2020). (In Russ.)

Supplementary files

Supplementary Files Action
Рис. 1. Составляющие системы нормирования труда

Download (6KB) Indexing metadata
Рис. 2. Численность взрослого населения (тыс.) на одну должность врача

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

Download (9KB) Indexing metadata
Рис. 4. Нормативное число должностей медицинских сестёр на 1 должность врача по Положению и по Порядкам

Download (7KB) Indexing metadata
Рис. 5. Динамика планово-нормативного и фактического числа коек по психиатрии-наркологии (на 10,0 тыс. населения)

Download (12KB) Indexing metadata



Abstract - 33

PDF (Russian) - 3


Article Metrics

Metrics Loading ...



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

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies