Basic information

  • Number of inhabitants in December 2008: 2 048 619

  • Average life expectancy: 73.76 years

  • Gross domestic product (GDP) per capita: 2 980.00$

  • Unemployment rate: 32.4 [1]

  • Health expenses for 2006 (% of GDP): 7.02%

  • Causes of death, in general: circulatory system diseases - 57.3% of the total number of deceased, neoplasm’s - 18.5%, endocrine, nutritive, and metabolic diseases - 4.2% etc [2].

Organization of the health care system in the Republic of Macedonia: preventive health activity

Before the breakup of the SFR of Yugoslavia, there was no private medical practice in the health system of the Republic of Macedonia (considered as a member of the SFRY). All the citizens were included in the concept of national health or general health care in which the access to the health care services was available for everyone, medication was free of charge and health insurance was general and obligatory.

Up to 1991 the preventive medical activity was organized in the confines of the integrated public health sector through the organizational units in public health institutions with clearly defined assignments, authorities and designation.

With the radical upheaval in social organization after 1989, and the adoption of the liberal model of social organization, in which private property and market were dominating, the concept of health care is becoming insufficient and inappropriate to cover the concept of public health.

Today, the health system in Macedonian is organized by public or private property health institutions divided on three levels: primary, secondary and tertiary health care (Fig. 1).

Fig. 1
figure 1

Health institutions authorized in preventive health care

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In accordance with the Law on health care, the Law on health insurance and all acts for preventive care which resulted from these laws, authorized for health care are the health institutions from the primary health care (whether they have private or public character), health care establishments and some of the hospitals [3].

The specialized care is realized through the National Health Care Center (Public Health Institute) in Skopje, regional health care centers and hygiene-epidemiological sanitary units. Visiting-nurse service (visits by nurses) also includes parts of the public health function (Table 1) [4].

Table 1 Agreements of the Health Care Fund of Macedonia (HIF) with health care institutions that provide preventive health care [5]
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The health system and implementation of health care in most part of Republic of Macedonia, with over 85%, are financed by the Fund. The rest is financed from the state budget, various donations and direct payments made by patients for health services.

Legislation and other published documents and analysis—emphasis on preventive health care activity

Assembly of the Republic of Macedonia, the Government and the Ministry of Health set the legal framework for the functioning of the health system. Two major laws shape the health care system: health care law and the Law on health insurance [2]. From the time Macedonia gained independence, till today, all the important laws are passed from the field of health care that also cover preventive health care activity.

The passed laws and other acts correspond to the full extent to the reform processes of the health section and the recommendations from WHO and EU (Table 2: Overview of the fundamental acts that affect the organization of preventive health care activity).

Table 2 Overview of the fundamental acts that affect the organization of preventive health care activity
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However, their accomplishment is influenced by the period when they were passed, the constant alterations and the overlap of the authorities.

There are very few documents that have been issued since the period when the acts were passed until their implementation in present and which refer to the results of the utilization of the measures, the advantages and disadvantages of the preventive health activity. Some of them are presented in Table 3.

Table 3 Preview on issued documents
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Advantages and disadvantages of the health system—the emphasis on preventive health activity

  • ➢ Health care in Macedonia is available to the population according to geographical, economic and weather factors, represented by a solid network of health care;

  • ➢ A Health strategy of the Republic of Macedonia 2020 is adopted to ensure efficient and equitable health system, which determines the vision to promote and improve the health system that meets the needs of the population, with clear strategic goals to improve preventive health care and strategic plan for its implementation;

  • ➢ The funding of the programs for preventive health care is mainly from funds from the central budget and the Health Insurance Fund;

  • ➢ Many of the laws and bylaws for the support of the strategic goals are being adopted;

  • ➢ In the Law of health care and legal acts, the indicators for success of implemented measures and preventive care programs are not defined as well as the control of laboratory tasks arising from it;

  • ➢ The frequent and inconsistent changes in key legislation without updating and publication of the revised text, as well as the overlapping of responsibilities of the institutions often lead to confusion and inappropriate use of them;

  • ➢ Interconnected regulations and bylaws adopted in a wide time period of a dozen years, leaving a space of action and significantly affect the overall quality of health care and in particular are affecting the preventive activity, given its specificity and social importance;

  • ➢ The structure of the health facilities with the enabled privatization has changed, thereby, the role of public health institutions has changed also (health centers and health stations) as a part of the leading institutions in the implementation of preventive health care;

  • ➢ Private primary health facilities have sufficient capacity to implement all measures provided by programs for preventive health care;

  • ➢ The monitoring, the control and the establishment of the measurable parameters of the carried preventive activities, are planned in several legal acts, where often competences are overlapping, but there is no clear act that would ensure the gathered data.

Conclusion

For improvement of preventive health care in Republic of Macedonia it is necessary to:

  • ❖ Preparation of purified, clear and consistent legislation to provide preventive health care, with clearly defined responsibilities for operations and monitoring of the provided services;

  • ❖ Providing adequate health network of public health institutions to establish departments responsible for implementing, monitoring and recording of the implemented activities from preventive health care;

  • ❖ Providing regular and reliable system of financing for preventive health care and

  • ❖ Taking measures to raise the health culture among the population with adequate promotion of public health.