Overview

North Macedonia’s health system provides a relatively comprehensive basic benefits package, with about 90% of the population being covered under the social health insurance scheme. Public spending on health has declined in recent years and is among the lowest in South-Eastern Europe. There is strong reliance on out-of-pocket payments which represented 40.4% of total health spending in 2019, one of the highest shares in South-Eastern Europe. Consequently, catastrophic health spending remains a problem, particularly for poorer households, and is largely driven by out-of-pocket payments for outpatient medicines.

The information system Moj Termin (‘My Appointment’) has greatly improved scheduling and waiting times for clinical appointments and diagnostic tests, but legal and operational barriers continue to undermine its use in primary care settings.

North Macedonia was hit harder by the COVID-19 pandemic than many other countries, particularly during the second and third waves, with high rates of excess mortality. Essential health services were disrupted, but e-health interventions were leveraged as part of the emergency response.