Full-time medical workers provided health care in their own workplace, but with extra time and under contracts signed with outside entities. In doing so, they compromised their own safety and that of their patients. In addition, the hospitals did not properly pay social security contributions," was the conclusion of an audit conducted by the Supreme Chamber of Control at four hospitals in the Podkarpackie region.
NIK: Apparent outsourcing in hospitals is a security risk
Published July 31, 2024 10:24
fot. Piotr Wójcik
Apparent outsourcing of health care services is a situation in which a health care entity enters into a civil contract with an outside entity for the provision of health care services by its own full-time employees. In this way, doctors, nurses, paramedics and other employees perform these services in addition to their full-time employees' working hours.
"The provision of services is carried out under the direct supervision of the management of these hospitals, during the hours determined by the management of the hospitals, with the help of equipment, medicines and other materials belonging to the hospitals, and the work performed under outsourcing contracts is of a kind identical to that performed under an employment relationship. The Law on Publicly Funded Health Care Services prohibits public health care facilities from signing contracts to provide medical services with their own employees," the NIK explains.
Judicial jurisprudence indicates that to operate in this way is to circumvent the regulations governing the employment relationship and social security contributions, as well as the regulations governing the working hours of medical employees. This constitutes a de facto continuation of full-time work. Working time standards for medical employees are observed only within the framework of full-time employment, and when the performance of the same services within the framework of contracts is added, the allowable working time is exceeded and the required breaks and rest time are omitted.
"This can have negative consequences for the health and lives of employees and patients, as well as for the provision of an adequate level of health services. To this should be added another negative effect in the form of understating the amount of social security contributions due - in a situation where a medical employee provides work for his or her employer, but under a contract signed with an outsourcer, the home institution should calculate and pay social security contributions also on the amounts earned with the outsourcer. And since the Law on Benefits prohibits hospitals from entering into contracts for the provision of health services with their own employees, so contracts with outsourcers should be treated as unnamed civil law contracts on which social security contributions are mandatory, the NIK auditors write in their report.
The audit covered 2019-2022 and five randomly selected hospitals in Subcarpathian province. Of these, four concluded contracts with external entities for the provision of health services by their own employees. There were 89 such contracts for a total amount of more than PLN 38 million.
"Staff shortages in health care are not an excuse here, as working extra time poses the risk of being overworked, distracted and making mistakes. In turn, this means that working extra time compromised the safety of both these medical workers and patients," according to the NIK.
The NIK requests that amendments to the law be initiated to eliminate the phenomenon of apparent outsourcing of health care services by setting standards for working hours and the right to rest by the employee in question, regardless of the number and forms of contracts they have entered into.
