Today, at the meeting of the Public Expenditure and Audit Commission of the Saeima, those present expressed concern about the inability of the Ministry of Health (MoH) to organize the remuneration system for medical personnel.
Today, at the meeting of the Public Expenditure and Audit Commission of the Saeima, those present expressed concern about the inability of the Ministry of Health (MoH) to organize the remuneration system for medical personnel.
The commission assessed how the MoI department is dealing with the implementation of audit recommendations from the State Audit Office. In total, the VC provided the ministry with 47 recommendations and two proposals, of which less than half have been implemented, Maija Āboliņa, a member of the VC Council, informed. The implementation of seven more recommendations has been delayed, while three related, for example, to e-health and the process of vaccination against Covid-19, have lost their relevance.
In the field of human resources in health care, five of the 19 recommendations have been implemented. The Ministry of Health (MoH) introduced the profession of general care nurse, as well as currently new professions or specialties are evaluated before inclusion in the list of regulated professions, the number of undergraduate and residency study places is gradually being balanced and the proportion of practice in the nursing education program is increased.
Aboliņa informed that the MoI continues the implementation of recommendations in the field of human resources. The to-do list includes promoting the number, qualification and placement of the industry’s human resources in line with the demand, conducting a comprehensive evaluation of the regulated professions and specialties of the health care industry, as well as improving the certification and recertification process of medical personnel.
On the other hand, in the audit “Is rehabilitation a full-fledged part of health care services?” out of seven recommendations, six have been implemented, and the implementation of one recommendation is still ongoing. Currently, recalculations of medical rehabilitation tariffs have been made and payment for services has been brought closer to actual costs, rehabilitation service providers have been selected according to special criteria, an intersectoral agreement has been reached on the exchange of data for the possible analysis of the increase in incapacity and disability, as well as a unified and standardized approach to the evaluation of patients’ functioning has been introduced.
VK expects that the Ministry of Health will take actions in 2023 to improve family doctors’ understanding of the importance of rehabilitation and the need to send the patient for further evaluation.
Regarding the increase in the remuneration of medical personnel at the Paula Stradins Clinical University Hospital (PSKUS), it was concluded that one of the five recommendations has been implemented, while the implementation of four recommendations is ongoing. Áboliņa informed that the salary elements were reviewed, differentiated basic salaries for doctors were determined according to competences and experience, the proportion of basic salary/variable part was determined at 70%/30%, and the salary was increased for those medical personnel for whom it was unreasonably lower. Also, in 2021, the new remuneration model was introduced in the internal medicine clinic as part of the pilot project.
However, so far there has been no progress on the VC’s proposal to the Ministry of Justice to organize the existing medical personnel’s remuneration system.
Aboliņa pointed out that there are significant deviations from the initial implementation deadline of the new remuneration model for medical professionals, as well as the working group of the Ministry of Health has not ensured the fulfillment of its tasks in 2022.
Taking into account the fact that there are guaranteed risks regarding the implementation of the new remuneration model, it will most likely not be implemented, said Rihards Kozlovskis (JV), chairman of the Public Expenditure and Audit Commission of the Saeima.
Boriss Knigins, Deputy State Secretary of the Ministry of Finance for Financial Affairs, admitted that the salary model was approved with a delay of two or three years. He added that the approved model has completely changed in the meantime and does not correspond to the reality that was approved by the Cabinet of Ministers. “What the industry had agreed on is no longer appearing in the model – both the pay increases that were expected and the responsibilities that treatment facilities would have to undertake to fix the pay model. Funding is needed to implement the model because, by equalizing and fixing of the relevant remuneration model system in hospitals, in return there are expenses for arranging the remuneration system. Looking at pilot projects in university hospitals, around 40 million euros were needed to introduce the model there,” explained Knigins.
He pointed out that the industry needs about 250 million euros for the implementation of the model in successive years. Therefore, implementing it by 2027 is said to be troublesome.
“The industry is changing, but what is stable is that we can never agree on the necessary funding for the industry. We fight for it every year,” Knigins said.
PSKUS board chairman Rinalds Muciņš pointed out that the salary is something that “will always be too little”, and there is always an aspiration for something bigger and better, and the hospital is no exception. He explained that the hospital’s common salary budget is 96 million euros, and this year it received an additional 4% in order to carry out reforms, equalize the coefficients, which is also done by increasing the fixed part and reducing the variation coefficient.
“There is still a lot to be done, but the shortage of medical personnel is large, and we are forced to count on each employee. Negotiations on salary are very difficult, and step by step progress is being made to make improvements,” Muciņš admitted.
According to him, currently the hospital is in a situation where the money is no longer available, because there are no people who are ready to work for the existing remuneration. He pointed out that “the staffing hole is very heavy”, they reduce the workload and gradually slide away to the private sector or even provide assistance to other countries.
