Macedonia (Republic of North)

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Eastern Europe and Central Asia

7.9%CHE/GDP

38.9%OOP/CHE

12.8%GGHE-D/GGE

14BGDP (USD)

2.1MPopulation

1.7%Unmet Needs - Total

1.8%Unmet Needs - Female

1.7%Unmet Needs - Male

The Republic of North Macedonia is an upper-middle-income landlocked country in Southeast Europe, on the Balkan peninsula, with a population of 1.8 million people and life expectancy of 74.4 years.
The following description by the European Observatory on Health Systems and Policies (the Observatory) gives an overview of the social health protection system in North Macedonia.

North Macedonia has a centralized health system with a single public payer
North Macedonia’s health system is largely financed through a social health insurance scheme operated by a single-payer Health Insurance Fund (HIF) that acts as the main purchaser of publicly funded health services. The social health insurance scheme is funded through contributions and government budget transfers pooled by the HIF. The Ministry of Health has a central role in the decision-making process in most health-related activities, whereas the Ministry of Finance determines the HIF budget.
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More than 90% of the population has access to a broad benefit package, but cost-sharing can be substantial
About 91% of the population is covered …. The HIF provides a broad basic benefit package that covers emergency care, primary and secondary outpatient care, inpatient care, and preventive and rehabilitation services of providers contracted by the HIF. In addition, the HIF covers some dental and mental health care services, medical devices, prescribed medicines and compensation for sick and maternity leave. Preventive services are available to all residents and are directly paid by the Ministry of Health. Most primary care services are free of charge but certain health services, in particular outpatient specialist visits, prescribed outpatient medicines and inpatient care, require user charges (co-payments) … Overall, co-payments are capped at EUR 98 per service and there is an annual income-related cap on co-payments.

North Macedonia’s current health expenditure of 8.52% of GDP is lower than the EU average of 10.95% in 2021, it has significantly increased in recent years (from 6.46% in 2018). The domestic general government health expenditure as a percent of general government expenditure is 13% (lower than the EU average 15.71%), and it has been around that level since 2003, indicating a stable commitment to the mobilization of resources. Per capita spending is low, at Int$ 1,535 in 2021 versus Int$ 5,227 in the EU on average, more than a three-fold difference. Only 54.5% [6] of health spending is publicly funded, which is much lower than the EU average (76.5%), and a relatively high share, 41.7% constitutes out-of-pocket spending (OOP).^[1] Social health insurance contributions constitute the largest source of public funding for health (37% of total current health expenditure), followed by government transfers (17.5%), and voluntary prepayments, which grew to make up 2.7% of total current health expenditure in 2021.^[1] Per the Observatory, OOP spending mainly consists of co-payments for services partly covered by health insurance and of direct payments for medicines and health services not covered by social health insurance. In addition, informal payments are common in certain health services. It was reported that poorer households suffer from catastrophic health spending driven by OOP payments for outpatient medicines, with 9% of households experiencing catastrophic spending in 2020.

North Macedonia succeeded in implementing a national e-health system called Moj Termin (My Appointment), reducing waiting times and other barriers to care. Reforms also included the reduction of hospital beds for higher efficiency of health infrastructure. In addition, the Observatory reported about recent comprehensive reforms in primary health care that introduced a community-oriented care model and emphasized health promotion and disease prevention:

In February 2019, the Ministry of Health launched a national reform of the primary health care system in line with the Astana Declaration, with the aim to introduce a new primary health care model of integrated and patient-centred care to make further progress towards universal health coverage.

References

[1] World Health Organization, Global Health Expenditure Database, (choose North Macedonia)