Agenda: additional guarantees for providing free medical treatment, special social benefits for certain categories of medical professionals, lump-sum monthly allowance for child birth and child-rearing, and the extension of the moratorium on inspections of businesses.
Meeting with deputy prime ministers on current issues
Mikhail Mishustin’s opening remarks
Tatyana Golikova’s report on additional state guarantees for providing free medical treatment
Dmitry Grigorenko’s report on extending a moratorium on inspections of businesses
Mikhail Mishustin: Good afternoon, colleagues.
The President has set the task of providing more affordable and higher quality medical treatment and making sure that all citizens of our vast country see positive changes and trends in this sphere.
The Government has extended and expanded the Programme of State Guarantees for Free Medical Care until 2025. Notably, it stipulates high-tech and specialised assistance. We are expanding the number of affordable services and the medical rehabilitation potential. From now on, patients will undergo rehabilitation at home, and they will receive the required medical devices. The programme includes new aspects, such as hepatitis C prevention and treatment, as well as early diabetes screening, diagnosis and treatment.
Ms Golikova, please tell us in greater detail about additional guarantees for providing free medical treatment to people.
Tatyana Golikova: Mr Mishustin, colleagues,
I will focus on the changes in this year’s programme.
First, we added 295 billion roubles to the programme as regards mandatory health insurance in 2023, including an 8.5 percent increase in the payroll budget. Spending on high-tech medical services will go up by almost 8 billion roubles, which is expected to pay for 1.3 million high-technology interventions.
There will also be a 14 percent increase in primary medical care and a 35 percent increase in medical rehabilitation services in 2023.
Second, as you have already said, Mr Mishustin, the programme contains provisions enabling people with reduced mobility, as well as those living in remote and rural areas, to obtain the rehabilitation services they need at home.
At the same time, healthcare institutions will have the right to provide these patients with the medical devices they need for rehabilitation, as well as mobility aides and devices that compensate for temporary loss of function. The programme includes resources for the regions so that they can buy these items.
Not all primary healthcare institutions have enough medical rehabilitation specialists. Accordingly, the programme sets forth provisions enabling doctors in these institutions to carry out telemedicine consultations with external rehabilitation doctors, including from federal institutions. It will be up to the regions to sign the relevant tariff agreements to pay for these consultations.
Third, this will be the first year when a separate budget will go towards regular medical check-ups for patients suffering from chronic diseases, which is critical for preventing complications, as well as for offering these patients timely treatments. Under the programme, regional health ministries and medical insurers will be tasked with overseeing these regular check-ups.
Fourth, the programme contains provisions on medical teams offering primary medical and sanitary services in remote and rural communities.
The heads of the nearest healthcare institution with which people living in these communities are registered will determine the operating schedule for the mobile medical teams and make sure to inform local residents about it. Therefore, I am asking the heads of regions to take this provision under their control.
Fifth, in November 2022, the Government, acting in accordance with the President’s instructions, approved an action plan to combat chronic viral hepatitis C. The programme includes the relevant provisions for implementation, such as a procedure for funding medical services for hepatitis C patients at day and around-the-clock hospitals, from the mandatory medical insurance fund, as well as the approval of charge tariffs for these services in the regions’ tariff agreements. In this context, the Health Ministry is to approve clear criteria for this category of treatment by 1 March 2023.
Sixth, as per the President’s instructions on improving healthcare services for diabetes patients, the programme includes a list of specific measures, including funding for Healthy Living Schools for diabetes patients from the mandatory medical insurance fund, which will allow us to increase the volume of medical services.
Seventh, the programme has been augmented with provisions for off-site medical care to be provided by federal healthcare facilities at the patient’s place of residence or location and, if necessary, for the patient’s evacuation.
And eighth, this year the programme has been augmented with provisions under which the Federal Fund for Mandatory Medical Insurance will analyse and compare healthcare facility spending relative to the overall spending pattern in 2022. If there are any discrepancies, the fund is required to inform the Ministry of Health and the regional authorities, which must immediately take response measures.
Mikhail Mishustin: Thank you, Ms Golikova.
It is important to make free medical care, including specialised and high-tech assistance, accessible to people throughout our country. The quality must be determined by a uniform approach rather than a person’s place of residence. The necessary funding has been allocated for this.
Another decision concerns additional support for Russian medical workers that help people with their health and their lives basically without any days off at district hospitals and outpatient clinics, rural health posts and emergency and ambulance services.
Fulfilling the President’s instruction, the Government established, starting 1 January 2023, special social payments for doctors, paramedical and junior medical staff that work in primary healthcare and ambulance services or who are fulfilling their professional duties in rural areas or remote, difficult-to-access regions. One more category of specialists is entitled to additional payments – experts, including those with higher non-medical education that are doing sophisticated research used, for instance, in diagnosing oncological diseases. The resolution on this has been signed.
These supplemental salary benefits range between 4,500 and 18,500 roubles per month, depending on the specialty. Overall, about 1.1 million people in the country will receive this benefit, including those in the recently acceded territories. Over 152 billion roubles have been allocated this year for this purpose.
Now it is necessary to take the necessary measures for these additional payments to be made without delay. Every doctor, paramedic or nurse must receive what he or she is entitled to. I would like to draw the attention of the heads of regions and of medical institutions to this.
Payments of lump-sum monthly benefits that incorporated a number of current social measures began on 1 January. This applies to benefits for the birth or adoption of a child until they are 3 years old, and to payments for children between 3 and 17 years. Now pregnant women with low incomes are also entitled to this allowance. Their individual material status is considered in each case.
Ms Golikova, we have been working hard on this. Please, tell us in more detail about this work.
Tatyana Golikova: Mr Mishustin, colleagues. I would like to start by discussing the special social payments to certain categories of medical workers. As you said, these payments became effective on 1 January 2023 and will be made available on top of the adjustments to the wage fund which are provided for by the state guarantee programme.
First, the special social payments due for a calendar month will be calculated based on the total hours worked during the reporting month. Medical workers will receive payment status notifications on the unified public services portal.
Second, payments will be made by the Social Fund from the mandatory health insurance fund.
No later than the 10th business day following the end of the reporting month medical organisations will send electronic lists of employees containing the information that is required for calculating payments for the month under review to the Social Fund. Thus, the first social payments for January 2023 will be made in February 2023.
If for organisational, technical or other reasons, a payment has not been assigned to an entitled medical worker in the first quarter of 2023, it will be paid in full in the second quarter of 2023 for the period starting on the date of accrual of that right.
The Social Fund is ready to implement this resolution. To ensure a smooth process for these special social payment benefits, the software used by the Social Fund has been updated to make sure that medical organisations that were unable to update their proprietary software by that time can use it without charge when sending these lists.
Third, medical workers will receive special social payments in the Donetsk and Lugansk people's republics and the Kherson and Zaporozhye regions as well. Regional branches of the Social Fund are training the staff at medical organisations operating in these territories and developing ways to obtain medical worker lists and to identify payment transfer options, including through the Russian Post.
Fourth, the federal authorities with subordinate medical organisations and the regional public health authorities need to create lists of medical organisations whose employees are eligible for these special social benefits.
I would like to put a special emphasis on the following three points.
My fifth point is that the resolution contains a recommendation that regions offer special social allocations from their budgets to healthcare workers who are paid from the regional budget and provide ambulance services, primary medical services, including regular medical exams, which are not covered under the basic mandatory health insurance programme.
Sixth, it is equally important that effective 1 January 2023, a healthcare worker’s salary cannot be lower than what was paid in 2022, taking into account the adjustment for inflation and the special social benefits. I am asking the regions to pay special attention to this matter.
Seventh, for the purpose of overseeing the payment of special social benefits the resolution instructs the relevant federal institutions and executive agencies in the regions to inform the Ministry of Health in a timely manner about any changes to the staffing lists of a medical institution leading to an increase in the number of those entitled to this special social benefit, so that the ministry can assess whether these changes are justified in terms of the number of people served by the institutions in question and the workload the healthcare workers have.
The Social Fund will forward information on the special social allocations to the Ministry of Health and the Ministry of Labour of Russia, and will monitor their distribution.
Mr Mishustin, colleagues, I will now move on to the monthly allocations for newborns and children’s upbringing.
Let me remind you that about 10 million recipients are entitled to this benefit, which is designed to form an integrated social safety net for families with children. This single allocation will be based on the social treasury principles. What does this imply? This means that beneficiaries only have to file a single application without excessive paperwork, and that all recipients will benefit from the same terms regardless of their status. The Social Fund will manage the distribution of this single benefit. In 2023, funding for this will be almost 1.7 trillion roubles.
As of 8 January 2023, the Social Fund approved this single benefit for 185,000 children under 17 years old and 4,000 pregnant women. The total number of applications for this new payment received so far exceeds 850,000, including 1,500 from people in Russia’s new regions.
The Government of the Russian Federation has defined special terms for paying this single benefit to people in the new regions. They can file applications and provide the required information in hard copy, rather than online, and the zero income rule will not apply to them. Recipients will be entitled to the single benefit even if they lack any official income. In addition, people in the new regions can receive the single benefit not only in their personal accounts or by post, but also at the Social Fund offices. We started accepting applications for the single social benefit on the public services portal before the New Year holidays, on 28 December, just as we discussed. The Social Fund’s client offices started accepting applications from parents as early as 4 January. Families and expectant mothers will start receiving payments this week.
The Social Fund and the Ministry of Labour will accompany the transition to a single social benefit, including by ensuring that it is justified and paid on time, as well as by informing people about the terms and procedures related to obtaining this new benefit, and ensuring convenience and accessibility when applying for the benefit and receiving it.
Mikhail Mishustin: Thank you, Ms Golikova.
It is extremely important for all of these payments to be made to people without delay. Ms Golikova, I would like you to personally monitor this matter.
Now let’s get to the next issue. The Government continues to reduce the administrative workload on businesses. The inspection moratorium has been extended through 2023. Starting this year, inspections will only be held at extremely high and very high-risk facilities.
Planned inspections can be cancelled if preventive inspection visits have already been made at the initiative of organisations that are to be inspected. Surprise inspections will be made upon the instructions of the President or the Government or at the request of prosecutor‘s offices or based on an oversight agencies’ information on a potential risk of violations of the mandatory requirements.
Mr Grigorenko (Deputy Prime Minister of the Russian Federation and Chief of the Government Staff Dmitry Grigorenko), you are responsible for this area. Please, tell us in more detail about the effect of that moratorium last year. What do you plan to do next?
Dmitry Grigorenko: Good afternoon, Mr Mishustin, colleagues. Indeed, following the President’s instruction, the Government is steadily improving its monitoring and oversight activities. The main goal of this work is to reduce the administrative burden on businesses while pursuing the interests of the state and society.
Thus, the specialists are upgrading the regulatory framework and updating the rules and requirements that businesses must fulfil in their business activities and that are a subject to inspection.
I would like to recall that over 318,000 regulations and requirements were analysed. Almost half of them, or to be precise, a bit over 143,000 were cancelled and about 120,000 updated.
This improvement in legal regulation allowed businesses to save about 200 billion roubles every year. This is the estimate of the business community.
And, the number of inspections is steadily decreasing, partly due to the adjustments in the regulatory framework.
Thus, a bit over 1.5 million inspections were held in the representative year of 2019 compared to about 350,000 last year. This is a more than four-fold reduction.
Mr Mishustin, as you said, in accordance with the President’s decision, the Government has extended the moratorium on inspections for this year with the exception of high risk and extremely high risk sites. The moratorium will not include risk-based inspections.
So, inspections in 2023 can be carried out only in cases of potential violations of the law where risk cannot be prevented without conducting an inspection. The lower the risk grade of a site the less eligible it will be for an inspection and vice versa.
Building feedback with the business community and entrepreneurs is another important building block. We have launched a service on the public services portal to handle complaints about the actions and decisions made by inspection bodies. This service has a separate tab for filing complaints about moratorium violations. This tab is used rarely, but it is used nonetheless.
The regulatory period for reviewing complaints on moratorium violations or potential violations is 24 hours. This time limit is strictly enforced, including using the information systems that record the duration and the results of considering complaints and requests.
Thus, improving the risk indicators and receiving feedback from businesses will make it possible to implement the mechanism for an exclusively risk-based approach to inspections, which, in fact, is the main goal of the Government this year as part of the efforts to improve monitoring and oversight activities.
Mikhail Mishustin: Thank you, Mr Grigorenko.
Of course, we must continue to improve the current inspection mechanism and introduce a risk-based approach. Most importantly, our goal is to reduce the administrative burden on companies that comply with the rules and do not pose a danger to human health or the environment and to keep monitoring high risk sites.
