Concept of collective agreement
One of the key instruments for protecting doctors is the collective agreement. In most healthcare institutions, old-sample collective agreements continue to operate, which were created when doctors received fixed funding from the state, and a doctor’s salary was calculated according to a tariff scale. These agreements do not take into account the new realities at all. As a result, some managers treat the hospital money as if it were their own – the salaries of management and ordinary doctors can differ by an order of magnitude.
Model for calculating salaries of medical workers
One of the most important subsections of any collective agreement is the mechanism for calculating the financial remuneration of a physician.
Thus, today several models of remuneration of medical workers are being developed:
- Salary plus bonuses.
A base salary is set for employees. Based on the results of accounting for personal performance, the performance rate can be supplemented with bonuses. Bonuses are determined based on various indicators such as patients’ satisfaction, employee’s performance, productivity, or a combination of the above.
- Share of the medical institution income.
This model assumes the distribution of shares of the institution profits among the health care employees. This distribution of funds creates an interest in increasing the profitability of the entire institution. However, this model does not take into account the personal achievements of the employee – experience, acquired skills, quality of medical services.
- Income dependent on earned funds.
The model eliminates the disadvantage of the previous one by linking the salary amount to the income that the employee has provided the institution with his own labor. At the same time, the funds allocated to cover the costs of maintaining the institution are preliminarily deducted from the proceeds.
In addition, several more salary calculation mechanisms are proposed, depending on the type of medical institution (emergency, primary or secondary healthcare) and whether there is competition.
In a situation with primary health care for hospitals in settlements with great competition (Kiev, Kharkov, Lvov, Dnepr and others), it is recommended to transfer to the so-called tariff-free system of remuneration – when the salary depends on the fulfillment of established norms (norms of time, production, service) and concrete results of work. According to this model, a fixed amount (capitation fee) is established for each patient.
For areas where there is no competition among medical institutions, the collective agreement proposes to establish a base number of patients for the service of which the doctor receives a rate. If the number is greater, there is also a bonus.
Experts from USAID, the Ministry of Health, and Kiev City Health Workers’ Union are currently drawing up updated guidelines for collective agreements conclusion.