The health care system of the Republic of Macedonia is developed so that it becomes compatible with the EU system, thus enabling free movement of the health professionals, services and patients.

The health care system provides:

  • Public health services aimed at both the community and individuals;
  • Generation of human and financial resources;
  • Proper financing of the health care sector: raising and merging sufficient financial resources, purchasing effective and quality services from the health care providers, and proper methods for paying them;
  • Recreation: effective and efficient organization and management of the health sector.

Role and function of the Ministry of Health 

  • prepares the health policy of the country and monitors its implementation;
  • establishes priorities in health care and monitors the functioning of the health care system;
  • performs an assessment of the organizational structure of the institutions in the system and the need for restructuring processes and/or formation of new institutions or activities;
  • monitors the effectiveness of the Health Insurance Fund management through a separate unit.

The Health Insurance Fund HIF is based on the principles of comprehensiveness, solidarity, equity and efficient use of funds. HIF supervises the insurance system by collecting funds from insurers and contracting service providers.

The Ministry of Finance in consultation with the Ministry of Health, defines the funds allocated for the health sector annually and includes preventive health programs.

The Ministry of Labor and Social Policy provides the necessary funds for health insurance for social services and people with special needs.

The state of the health care in Macedonia according to the level of health care is divided into:

  • Primary
  • Secondary and
  • Tertiary in the respective healthcare regions

As in many other countries, the health care system in Macedonia is oriented towards primary health care as the basis of the system, where the first contact with the health service is established and where most of the health needs of the population are met. Primary health care is the basis of the overall health system and offers basic health care at the local level.

The patients that need higher level health care are referred by the primary care physician to an outpatient polyclinic treatment or hospital treatment. The network of health facilities at the secondary level is generally widespread, with certain differences in terms of spatial capacity and availability of personnel and equipment. Despite the widespread network of different healthcare institutions, the system does not function as an integrated and coordinated system.

The East planning region of the Republic of Macedonia encompasses the Bregalnica river basin and covers an area of 3537 km2 or 14.2% of the territory of the Republic of Macedonia. The consists of 11 municipalities (Berovo, Vinica, Delchevo, Zrnovci, Karbinci, Kochani, Makedonska Kamenica, Pehchevo, Probishtip, Cheshinovo-Obleshevo and Shtip) which in terms of urbanisation are further divided into 217 human settlements, 209 settlements of which are characterised as rural settlement.

Demography

In terms of demography the region has similar demographic trends with the rest of the Republic of Macedonia. Over the last 5 years depopulation and decrease of the population has been recorded.

The population index for the year 2013 is shown on the following table.

The share of the population of the East planning region in the total population of the Republic of Macedonia has been decreasing in the last five years. The density of the population in the region amounts to 50.4 inhabitants per square kilometre. The population of the East planning region in 2013 lived in 72.248 housing units, with the average size of one household of 3.1 members. In the course of one year (2013) there were only 1540 new-born, which means that the birth rate amounts to 8.6 permille. In the same period, the number of deaths was 1.851 indicating negative population growth which amounts to -311 persons or -1.74 permille. In 2013, 184 persons moved to the East planning region, while 55 left it.

The following table shows the national structure of the population in the East planning region

National population structure

Health institutions in the East planning region of the Republic of Macedonia

  • Health stations;
  • Health homes;
  • Private health institutions;
  • General hospitals;
  • Clinical hospitals;
  • Private hospitals;
  • Institute for public health Macedonia, Centres for public health – Municipality of Shtip and Kochani. 

Primary health care 

Primary health care in Macedonia is provided by various types of private and public health organizations: doctor’s offices, health stations and health houses. Preventive, promotional and curative services are provided in the primary health care, provided by various types of healthcare workers and associates: general medicine service, labor medicine service, child health care services for children between 0-6 years, health care service for school children and youth, the women’s health protection service through general physicians, specialists in general medicine, pediatricians, specialists in school age medicine, gynecologists, and specialists in occupational medicine. As in many other transition countries a large number of doctors have set up their private health clinics. Currently, 607 of 1,722 doctors from primary care (most of them general practitioners, pediatricians and gynecologists) work in the private clinics (source: Ministry of Health). Private primary care practitioners do not provide comprehensive primary care, including all preventive services and emergency care after working hours, i.e. do not provide continuous health care. The goal of privatization of primary health care is to improve the quality of health services. 

The East planning region of the Republic of Macedonia is divided into seven health regions: Berovo, Vinica, Delchevo, Kochani, Pehchevo, Probishtip and Shtip.

Demographic, vital and health indicators in the health care regions within the East planning region.

Health care workers with higher education in the Primary health care by activities in the

Health region Berovo

Health care workers with higher education in primary health care by activities in the

health region Vinica

Health care workers with higher education in primary health care by activities in the

health region Delchevo

Health care workers with higher education in primary health care by activities in the

health region Kochani

Health care workers with higher education in primary health care by activities in the

health region Probishtip

Health care workers with higher education in Primary health care by activities in the

health region Stip

Health institutions in the primary health care

Number of doctors by health regions within the East planning region of the Republic of Macedonia 

  • Health region Berovo – 39 doctors
  • Health region Vinica – 33 doctors
  • Health region Delchevo – 46 doctors
  • Health region Kochani – 94 doctors
  • Health region Probishtip – 30 doctors
  • Health region Shtip – 201 doctors

Classification of doctors by health regions as part of the East planning region of Republic of Macedonia

Health workers in hospital departments in general and clinical hospitals in the East planning region

Number of beds in hospital-stationary institutions

Network of medical units – places of primary and preventive health care in the health regions


Secondary and tertiary health care 

Secondary health care is provided by the specialist-consulting services, through general and clinical hospitals, divided into specialist-consultative health care services, responsible for outpatient assessment and treatment and hospital health care, offices and institutes. These services are available through a referral from the selected doctor.

Secondary health care – Specialist-consultative health care includes specialist diagnosis, treatment and rehabilitation. The same is carried out by the specialist clinics in health centers, outpatient clinics, clinics in the general and clinical hospitals, the medical rehabilitation service, as well as by the special hospitals. Tertiary health care is provided by clinical hospitals and the University Clinical Center. Preventive, healing and rehabilitation services are provided at these two levels, while health care is provided by different types of specialists and subspecialists.

Health institutions in secondary health care in the East planning region of the Republic of Macedonia

Health workers in specialist-consultative activity in secondary health care in the East planning region

Health workers in the field of medical rehabilitation in secondary health care in the East planning region

Health workers in the transfusion service in secondary health care in the East planning region

Health care workers in the service for dermal-venereal diseases in secondary health care in the East planning region