Initial response measures

All interventions for patients with chronic conditions that could be delayed have been postponed. Emergency and malignant cases are receiving the same treatment as before the outbreak. The Health Insurance Fund took a series of measures to facilitate services to its policyholders, whilst remaining in line with the interim measures taken by the government for the control of COVID-19. These measures include the simplification of administrative procedures at the primary care level (to effectively provide the most needed health services to patients) and to minimize unnecessary contact between GPs and patients, with referrals to a doctor only when really necessary. Measures for insurees, family doctors and pharmacies include:

• Patients can have consultations and receive approved sick leave (up to 14 days) from family physicians by telephone. In the case of the need for isolation and substitution of a family physician, the Health Insurance Fund allows the appointment of a second physician, and, if necessary, a third one.
• Family physicians are given special authority to prescribe for chronic conditions, rehabilitation prescription and other conditions without referral to a specialist. As of 13 March 2020, health insurance remains valid beyond the usual five years for the duration of the emergency, avoiding the need for administrative procedures for renewal.

As of 23 March 2020, people with diabetes who need to extend their insulin prescription can do so by phoning their specialist. The Red Cross Association has mobile teams that are addressing the needs of older people staying at home (for example, grocery shopping, drugs etc.).

Research conducted in the period from 16 to 22 May 2020 via telephone among 1000 respondents by the Macedonian Centre for International Cooperation (MCIC) found that a quarter of respondents postponed medical examinations due to COVID-19. The survey found that, in terms of negative feelings caused by the crisis, over 70% of respondents rarely or never cried, 48% said they did not feel nervous, and 50% said they did not feel depressed. For most respondents (71%) family relations did not change due to the corona crisis, and almost every fifth citizen (19%) said that the relations in the family have improved. National news on the pandemic were on average rated 3.4 out of a maximum of 5 points. Almost half of the respondents (48%) said that the information was conflicting and confusing. More than half of the respondents (55%) said they were not ready to use the “Stop Corona” application, but 21% said they were fully or somewhat ready for it.

The Clinic for Radiology and Oncology maintained services for its patients and informed the public on 12 April 2020 about protective measures for patients in times of COVID-19. In addition, the clinic provided psychological support of patients with oncological conditions.

A dedicated phone line (075/277-806) for support and consultations for people with dementia and their caregivers is available on Mondays and Wednesdays from 11:00–13:00, according to the University Clinic for Neurology.
WHO has been supporting the country to raise awareness about maintaining essential health services and importance of immunization in preventing diseases and protecting life at the time of COVID-19. Activities were held during the European Immunization Week 2020, from 20 to 26 April 2020.

The Health Insurance Fund introduced e-prescription for chronic conditions. Starting on 1 May 2020, people with chronic conditions were able to obtain or extend their prescriptions though a phone call and GPs are enabled to prescribe electronically.

In August 2020, the Clinic for Psychiatry reported that since March 2020 approximately 4000 telephone conversations had taken place to provide psychological support for citizens during the COVID-19 pandemic.

Transition measures

On 16 May 2020, it was announced that the 8 September Hospital, which was a designated centre for COVID-19 patients, would resume its regular work shortly. The COVID-19 centre will be reallocated to a different isolated area of the hospital, and the first floor of the hospital equipped with 20 respirators would be designated as an ICU for COVID-19 patients.

As of 21 May 2020, the Ministry of Health is restarting the appointment system for essential services in hospitals and primary centres. The consultation time slots scheduled via the e-health system “Moj Termin” are extended to last between 20 and 30 minutes to avoid queues and gatherings in the outpatient care units. Patients priority lists for delayed interventions are set up. Since the introduction of an e-prescription service in May 2020, over 3 million e-prescriptions have been issued electronically for chronic and acute treatment was reported on 29 June 2020.

On 15 June 2020, it was announced that, to prevent the spread of the virus, regular interventions for patients with chronic diseases would continue to be postponed, and only urgent and necessary interventions would be provided.

The government adopted the Action Plan for free vaccination of risk groups for the 2020/2021 season according to which the number of people to be covered with the flu vaccine would increase from 20 000 to 60 000 people from the following risk groups: adults over 65 years old, people with chronic health conditions, health workers, pregnant women and children from six months to five years old.

In July the Skopje city hospital “8 septemvri” – which had served as a COVID-19 centre – restarted surgeries with the arrival of new anaesthesiologists, although not all health services will be available to patients. The oncology clinic has continued chemotherapy and radiotherapy treatment since mid-May without interruption.

On 17 August 2020, the Ministry of Health announced that consultations and interventions could be scheduled again through the information health system “Moj Termin.” Patients whose consultations had been canceled in the previous period will be invited, as well as patients who need elective surgical interventions.

On 6 October 2020, the Ministry for Education and Science, the Ministry of Health and the Ministry of Labor and Social Policy, in collaboration with the University Psychiatry Clinic, established a phone line for support of the mental health of children, youth and parents.