The former Yugoslav Republic of Macedonia: health system review

ABSTRACT

This publication reviews recent developments in the organization and governance of the health system, health financing, health care provision, health reforms and health system performance of the former Yugoslav Republic of Macedonia. The country made important progress during its transition from a socialist system to a market-based system. Though total health expenditure has risen in absolute terms in recent decades, it has consistently fallen as a share of GDP, and high levels of private health expenditure remain. Despite this, population health has improved, with life expectancy and mortality rates for both adults and children reaching similar levels to those in the former communist EU countries. Inheriting a large health infrastructure, good public health services and well distributed health service coverage after independence in 1991, the country rebuilt a social health insurance system with a broad benefit package. Primary care providers were privatized and new private hospitals were allowed to enter the market. In recent years, the country reformed the organization of care delivery to better incorporate both public and private providers in an integrated system. Significant efficiency gains were reached with a pioneering health information system that has reduced waiting times and led to a better coordination of care. This multi-modular e-health system has the potential to further reduce existing inefficiencies and to generate evidence for assessment and research. Future challenges include sustainable planning and management of human resources as well as enhancing quality and efficiency of care through reform of hospital financing and organization.