Calculating compliance cost of obligations for the minimum and maximum number of fully equipped beds in oncology departments

Calculating compliance cost of obligations for the minimum and maximum number of fully equipped beds in oncology departments

1. THE PROCEDURE FOR PROVIDING
ONCOLOGICAL CARE TO ADULTS
(Implementation of extended SCM)
July 2021

2. At the draft stage, the
regulation was posted
on the Public Portal
without conducting
RIA:
https://regulation.gov.ru
/projects#npa=106759
17 724
The CASE
DESCRIPTION
Regulatorylegal act
Order of the Ministry of Health of the Russian
Federation of February 19, 2021 No. 116n “On approval
of the Procedure for providing medical care to the
adult population with oncological diseases”
Ørequirements for the minimum and maximum number of
beds in different types of oncology departments
Ørequirements for the placement of certain types of
departments within a single property complex
Øntroductionof "routing" of oncological patients
Key innovations

3. EXAMPLES OF REQUIREMENTS INTRODUCED BY the draft
regulation AND EVALUATED IN THE CASE STUDY
1) Medical organizations enter information about the provided
oncological medical care into the medical information system of
a medical organization for the subsequent transfer of
information to the State Information System
2) The bed capacity of departments of anti-tumor drug therapy:
from 20 to 50 beds;
3) The bed capacity of a radiotherapy department is determined
based on the calculation of at least 5 beds per 1 radiotherapy
unit except the cases of treatment on gamma therapy devices

4. premisesbeds staff
Cost estimate structure for complying with the Procedure
one
-off
recurring
•Costs of building and equipping
new premises
•Costs of relocating hospital
departments
•Rent of new premises
•Costs of maintaining new
premises (utility payments, etc.)
•Costs of acquiring and
equipping new beds
•Beds maintenance costs
•Costs of acquiring a stock of
medical consumables,
pharmaceuticals
•Time expenditures for ensuring
compliance with the regulatory
requirement
•Payroll fund

5. 70 000 rub/month -the average salary of a doctor (without deductions)
25 000 rub/month-average salary of an administrator (without deductions)
2 hours per week-a doctor's time expenditures for collecting and documenting information
about the medical care provided
2 hours per month -an administrator's time expenditures for entering data into the State
Information System on the medical care provided
On average, the staff of one department consists of 1 administrator and 2 doctors.
Medical organizations enter information about the provided
oncological medical care into the medical information system of
a medical organization for the subsequent transfer of
information to the State Information System
DATA
1

6. Medical organizations enter information about the provided oncological
medical care into the medical information system of a medical
organization for the subsequent transfer of information to the State
Information System
1) With a 40-hour work week there are about 160 working hours per month
We find laborcost of 2 doctors, taking into account the social deductions per year (for 52
weeks):
2 * 70 000 rub / 160 hours * 1.3 * 2 hours * 52 = 118 300 rub
2) We find labor cost of administrators, taking into account the social deductions per year
(for 52 weeks):
25 000 rub / 160 hours * 1,3 * 2 * 12 = 4 875 rub
3) Total recurring costs (information), per year (the sum of paragraphs 1 and 2)
118 300rub + 4 875 rub = 123 175 rub
CALCULATION
1

7. THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL ORGANIZATION <...> IF
THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY DEPARTMENT LOCATED WITHIN THE
PROPERTY COMPLEX
DATA(1)
125-the total number of radiotherapy departments in Russia
25-the number of clinics in Russia with a radiotherapy departments but without an anti-tumor
drug therapy department
10-the number of clinics with a radiotherapy department, while an anti-tumor drug therapy
department is remote from it (= not located within a single property complex)
10% of the construction cost-the cost of relocating an anti-tumor drug therapy department
1 500 000 000 rub -the average cost of building a new anti-tumor drug therapy department
8% -share of clinics that do not have an anti-tumor drug therapy department and will be
forced to close
100 000 000 rub -the average cost of maintaining an anti-tumor drug therapy department per
year
2

8. THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL ORGANIZATION <...> IF
THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY DEPARTMENT LOCATED WITHIN THE
PROPERTY COMPLEX
Staff for an anti-tumor drug therapy department according to
the standard (on average per 1 department that meets the
requirements of the Oncology Procedure)
Number of staff unitsAverage salary, rub
(excluding social
deductions), rub
Doctor 2 70 000
Nurse 9,535 000
Assistant nurse2 26 000
Hospital attendant9,524 000
Administrator1 25 000
DATA(2)
2

9. THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL ORGANIZATION <...> IF
THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY DEPARTMENT LOCATED WITHIN THE
PROPERTY COMPLEX
1)Costs of relocating an anti-tumor drug therapy department
We calculate the product of: The number of clinics with a radiotherapy department, while an anti-
tumor drug therapy department is remote from it * Cost of relocating an anti-tumor drug therapy
department * The average cost of building a new anti-tumor drug therapy department
10 * 10% * 1 500 000 000 rub = 1 500 000 000 rub
2) The number of an anti-tumor drug therapy departments to be built
We calculate the product of: The number of clinics in Russia with a radiotherapy department but
without an anti-tumor drug therapy department * (1 -share of clinics that do not have an anti-tumor
drug therapy department and will be forced to close)
25 * (1 –8%) = 25 * 0,92 = 23
CALCULATION(1)
2

10. 3) Construction costs for new anti-tumor drug therapy departments
The number of anti-tumor drug therapy departments to be built * The average cost of building a new
anti-tumor drug therapy department
23 * 1 500 000 000 rub = 34 500 000 000 rub
4) Costs of maintaining new anti-tumor drug therapy departments per year
The number of anti-tumor drug therapy departments to be built * The average cost of maintaining and
servicing an anti-tumor drug therapy department per year
23 * 100 000 000 rub = 2 300 000 000 rub
CALCULATION(2)
2
THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL ORGANIZATION <...> IF
THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY DEPARTMENT LOCATED WITHIN THE
PROPERTY COMPLEX

11. 5) Payroll Fund (including theunified social tax (UST) deductions) for 1 anti-tumor drug
therapy department, per year
We calculate the products of the number of staff units for each position by the average salaries
and sum it up. Then we multiply the amount by 12 months and by the UST rate.
(2 * 70 000 + 9.5 * 35 000 + 2 * 26 000 + 9.5 * 24 000 + 1 * 25 000) * 12 * 1.3 =12 129 000 rub
6) Payroll Fund (including deductions) for all new anti-tumor drug therapy departments,
per year
Payroll Fund (including the UST deductions) for 1 anti-tumor drug therapy department * The
number of anti-tumor drug therapy departments to be built
12 129 000 * 23 = 278 967 000 rub
CALCULATION(3)
2
THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL ORGANIZATION <...> IF
THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY DEPARTMENT LOCATED WITHIN THE
PROPERTY COMPLEX

12. 7) Total one-off costs (substantive)
Costs of relocating anti-tumor drug therapy departments + Costs of building anti-tumor
drug therapy departments
1 500 000 000 + 34 500 000 000 = 36 000 000 000 rub
8) Total recurring costs (substantive)
Сostsof maintaining new anti-tumor drug therapy departments per year + Payroll Fund
(including deductions) for all new departments per year
2 300 000 000 + 278 967 000 = 2 578 967 000 rub
CALCULATION(4)
2
THE DEPARTMENT OF RADIOTHERAPY IS ORGANIZED IN A MEDICAL
ORGANIZATION <...> IF THERE IS A 24-HOUR ANTI-TUMOR DRUG THERAPY
DEPARTMENT LOCATED WITHIN THE PROPERTY COMPLEX

13. 200 000 000 rub -the cost of creating and equipping one bed in a radiotherapy department
10% of the cost of a bed -the average cost of maintaining one bed in a radiotherapy
department / per year
308 -the number of radiotherapy units in Russia (linear accelerators + gamma-therapy
devices)
174 -the number of gamma-therapy devices in Russia
520 -the total number of beds in radiotherapy departments (for linear accelerators)
35 000 rub -the average staff salary per 1 bed (per month), excluding UST
300 000 rub -the cost of re-equipping the premises to accommodate 1 bed in a radiotherapy
department
35 000 rub -the average staff salary per 1 bed (per month), excluding UST
THE BED CAPACITY OF a RADIOTHERAPY DEPARTMENT IS DETERMINED ON THE
BASIS OF CALCULATION of AT LEAST 5 BEDS PER 1 radiotherapy unit,
EXCLUDING THE CASES OF TREATMENT ON GAMMA THERAPY DEVICES
DATA
3

14. 1) The total number of linear accelerators
We subtract the number of gamma-therapy devices from the total number of radiotherapy units
308 –174 = 134
2) The required number of beds (accounting for linear accelerators)
The total number of linear accelerators * 5
134 * 5 = 670
3) The number of missing beds
The number of beds required (accounting for linear accelerators) -Total number of beds in radiotherapy
departments (accounting for linear accelerators, actual value)
670 –520 = 150
CALCULATION(1)
3
THE BED CAPACITY OF a RADIOTHERAPY DEPARTMENT IS DETERMINED ON THE BASIS OF CALCULATION of AT LEAST 5 BEDS PER 1 radiotherapy unit, EXCLUDING THE CASES OF TREATMENT ON GAMMA THERAPY DEVICES

15. 4) Costs of creating additional beds
The cost of creating and equipping 1 bed in a radiotherapy department * The number of missing beds
200 000 000 * 150 = 30 000 000 000 rub
5) Costs of maintaining and servicing additional beds per year
The cost of creating and equipping one bed in a radiotherapy department * the cost of maintaining and servicing one bed
in a radiotherapy department / per year * The number of missing beds
200 000 * 0,1 * 150 =3 000 000 000 rub per year
6) Costs of re-equipping the premises
The cost of re-equipping the premises to accommodate one bed in a radiotherapy department * The number of missing
beds
300 000 * 150 = 45 000 000 rub
CALCULATION(2)
3
THE BED CAPACITY OF a RADIOTHERAPY DEPARTMENT IS DETERMINED ON THE
BASIS OF CALCULATION of AT LEAST 5 BEDS PER 1 radiotherapy unit,
EXCLUDING THE CASES OF TREATMENT ON GAMMA THERAPY DEVICES

16. 7) Staff costs per year
The average staff salary per 1 bed (per month), excluding social deductions * the UST rate * the number
of months (12) * the number of missing beds
35 000 * 1,3 * 12 * 150 =81 900 000 rub
8) Total one-off costs (substantive)
The costs of creating additional beds + costs of re-equipping the premises
30 000 000 000 + 45 000 000 = 30 045 000 000 rub
9) Total recurring costs (substantive)
Costs of maintaining and servicing beds per year + Staff costs per year
3 000 000 000 + 81 900 000 = 3 081 900 000 rub
CALCULATION(3)
3
THE BED CAPACITY OF a RADIOTHERAPY DEPARTMENT IS DETERMINED ON THE BASIS OF CALCULATION of AT LEAST 5 BEDS PER 1 radiotherapy unit, EXCLUDING THE CASES OF TREATMENT ON GAMMA THERAPY DEVICES