Система здравоохранения в Германии имеет следующие особенности:
— власть в больницах уже давно перешла в руки немедицинских менеджеров, которые пытаются управлять лечебным процессом как сборкой автомобилей на конвейре.
— амбулаторная помощь раньше осуществлялась через систему государственно регулируемых частных кабинетов. В настоящее время прослеживается тенденция создания объединений отдельных частно-практикующих врачей в «поликлиники»
— параллельно с этим существует множество частных стационаров.
— оплата мед. помощи идет по четко разработанным каталогам, в стационарах через DRG. Амбулаторная помощь делится на 2 части — врачи с «кассовым» допуском и частно-практикующие. В принципе, объем помощи и ее оплату, включая льготы, определяют страховые компании. При этом пациенты имеют возможность выбирать и менять кассу, что создает конкуренцию.
— Кассы и врачебные объединения определяют на каждый год необходимый бюджет и его распределение в рамках специальных заседаний.
Таким образом система здравоохранения Германии объединяет как частный, так и государственный сектор. Причем в частном секторе присутствует система гос. регулирования. Вопрос льготников и контроль за оказываемой им помощью лежит на кассах. Поэтому кассы определяют ассортимент доступных льготникам медикаментови регулируют таким образом количество денег, расходуемых на медикаменты. Этим оказывается также влияние на фармацевтические компании.
Мне кажется, что удержать процесс перехода кправления в медицине в руки «немедиков» не удастся, да это впринципе и не нужно. Необходимо создать систему «медицинских управленцев», которые понимают необходимость сотрудничеста с врачами. С другой стороны каждый, кто занимает должность зав. отделением и выше будет вынужден отвлекаться от чисто медицинской дефятельности и заниматься организацией процесса. Главное — это законодательно установить разумный баланс между двкмя этими видами деятельности. Одним из главных механизмов регулирования, конечно, является оплата труда. Здесь, в Германии разница в зарплате между шефом, его замами и простыми ординаторами принципиальная. При этом уровень зарплаты шефа напрямую зависит от его «успехов».
Статью подготовил и отредактировал: врач-хирург Пигович И.Б.
To: Head of Russian subsiduary “Dr. Falk FarmaGMBH”, Germany
Maksimov K.B.
Copy: Head of “Dr. Falk PharmaGMBH”, Germany
From: Kolesnikov Vladimir Valentinovich
Application
December 24, 2009 between me and Russian subsidiary «Dr. Falk PharmaGmbH» Germany (hereinafter referred to as the «Company») was signed employment contract number 0909. In accordance with an agreement concluded between the same parties February 14, 2014, said the employment contract was terminated by mutual agreement.
In accordance with the provisions of Art. 22 of the Labour Code of Russian Federation, the employer is obliged to comply with labor laws and other normative legal acts containing norms of labor law to pay the full amount owed to the employee wages in the terms established in accordance with the LC RF.
In accordance with Art. 57 of the Labour Code, required for inclusion in the contract of employment are, in particular: the conditions of payment (including the wage rate or salary (basic salary), bonuses, allowances and incentive payments).
At the same time, the law provides that «the failure to include in the contract of employment of any of the rights and (or) the duties of the employee and the employer cannot be deemed a waiver of the implementation of these rights or the performance of these duties.»
According to the paragraph 4.1 of labour contract num. 0909 monthly pay is 45000 Rub. Hereafter according to the additional agreement num. 2 dated 12 of March 2012 to the above mentioned labour contract salary was increased up to 55000 Rubles and according to the additional agreement num. 3 dated 30 of April 2013 to the same contract salary was increased up to 58000 Rubles.
According to the paragraph 4.5 of labour contract num. 0909 was also agreed that ” in addition to the established according to the paragraph 4.1 wage, worker may receive additional fees depending on the outcome of work. Sizes, order and payment terms are set by the employer in accordance with the internal local acts”.
With such internal local acts (including the » Compensation and Benefit Policy «, the link for which there is in my job description, I was not aware.
By virtue of the Labour Code (Article 129 of the LC RF ) wages ( deductibles ) — remuneration depending on the employee’s qualifications , complexity, quantity , quality, and conditions of work , as well as compensation ( bonuses and allowances compensatory nature , including work in conditions that deviate from the normal , working in special climatic conditions and in areas affected by radioactive contamination , and other payments compensatory nature ) and incentive payments ( bonuses and allowances stimulating character , bonuses and other incentive payments) .
Thus, in the employment contract number 0909 entered into between me and the Company, in violation of the provisions of the LC RF, was not determined the size of my salary and not specified bonuses and allowances. The provisions of paragraph 4.5 of the contract of employment between those suggest that the amount specified in paragraph 4.1. the same contract is not actuall salary (remuneration, comprising as payment for work, and all allowances and additional payments, other payments) and represents only a portion of salary.
In accordance with the provisions of paragraph 21 of the LC RF, the employee has the right to timely and full payment of wages according to their skills, complexity of work, the quantity and quality of work done.
In accordance with paragraph 146 LC RF, compensation of employees engaged in work in areas with special climatic conditions, is produced at a higher rate. Article 148 LC RF guarantees wages at a higher rate to employees engaged in work in areas with special climatic conditions, in the manner and amounts not less than the labor legislation and other normative legal acts containing norms of labor law. This rule is enshrined in Article 316 of the LC RF, provides that wages of people working in the Far North and equivalent areas, carried out with the use of regional factors to salary. A similar legal regulation contained in the Law of the Russian Federation dated February 19, 1993 N 4520-1 «On state guarantees and compensation for those working and living in the Far North and similar areas.»
In accordance with the RF Government Decree of 13.05.1992, № 309 «On increasing regional factors in certain areas and cities of the Tomsk region» for the city of Tomsk regional coefficient 1.3 is installed.
In accordance with Art. 136 LC RF, the payment of wages the employer is obliged to notify in writing each employee:
1) about the components of wages due to him for the relevant period;
2) the amount of any other amounts accrued to the employee, including monetary damages for breach of the employer deadline respectively wages, vacation pay, severance payments and (or) other payments due to the employee;
3) the amount and the basis of deductions;
4) the total amount of money to be paid.
Meanwhile, for all time in the Company’s payslip salary payment I never were given.
In these circumstances, I figured that I paid wages Company includes, in particular, regional coefficient (1.3) accrued as per my salary and allowances and additional payments to this contract, as well as all the bonuses provided remuneration system of the Company.
However , after the termination of the employment contract between me and the Company , some of the statements of representatives of the Company’s management ( in response to my request to the management of the Company , to provide me Information on individual income) , gave me reason to doubt that during the period of my work in the employer to properly perform its obligations under applicable law to accrue on my actual earnings ratio and the district to pay me a salary in full ( with the inclusion of the regional coefficient ) .
In accordance with Art. 140 LC RF, at the termination of the employment contract, all sums owed to the employee by the employer, on the day of the employee’s dismissal.
In view of the foregoing, I ask:
1. Provide me as soon as possible payslip wage Vladimir V. Kolesnikov for the entire period of the employment contract number 0909 entered into between me (Kolesnikov VV) and Russian subsidiary «Dr. Falk PharmaGmbH» Germany.
2 . If within the employment contract term number 0909 entered into between me ( Kolesnikov VV ) and Russian subsidiary «Dr. Falk PharmaGmbH » Germany ( fully or partially) on my salary , allowances and additional payments to this contract, as well as bonuses provided by remuneration system of the Company, the Company had not been recorded regional coefficient, to the extent provided by RF Government Decree of 13.05.1992 № 309 «On increasing regional factors in certain areas and cities of the Tomsk region» , and if such coefficient been recorded , but accrued amounts not paid me — immediately pay me for lost all my wages.
It is with deep regret that in the case of non-response to me this statement as soon as possible, I will be forced, in order to protect my interests, safeguard the rights of other employees of the Company, refer to the appropriate legal action, as well as appeal to the federal labor inspectors and the authorities supervising the execution of the tax legislation.
Sincerely,
Vladimir V. Kolesnikov
30.03.2014 г.