Overview

Key points

• North Macedonia’s health system provides a relatively comprehensive basic benefits package, with more than 90% of the population covered under the social health insurance scheme.
  
• Public spending on health increased in the COVID-19 pandemic, but remains amongst the lowest in south-eastern Europe.
  
• There is a continued reliance on out-of-pocket (OOP) payments which accounted for 41.7% of health spending in 2021, one of the highest shares in south-eastern Europe.
• Most primary care services are free at the point of delivery but there are user charges for inpatient care and specialist outpatient visits and medicines.
  
• Catastrophic health spending remains a problem for poorer households, largely driven by OOP payments for outpatient medicines.
  
• Unmet needs for medical care due to cost have declined over the last decade but remain relatively high in low-income groups.
  
• Primary care is provided mostly by private solo practices but reforms envisage multidisciplinary teams.
  
• Hospital and bed numbers have been falling but occupancy rates are still low.
  
• Rates of doctors and nurses are relatively low but have increased in the last decade, although migration is a challenge.
  
• The information system Moj Termin (My Appointment) has reduced waiting times for appointments and diagnostic tests.
  
• The COVID-19 pandemic had a severe impact on life expectancy.
  
• Childhood immunization was falling even before the pandemic and continues to decline, although maternal and infant mortality rates have improved markedly in recent years.
  
• Noncommunicable diseases are a major concern, but mortality from stroke and ischaemic heart disease has decreased in recent years.
  
• High blood pressure, smoking, unhealthy diet, high blood sugar, and air pollution all represent significant risks and overweight and obesity are increasing.