Креирање политики за подобрување на пристапот до здравствените услуги на населението: Расчекор меѓу желбите и практичната примена

Владимир Лазаревиќ



The Republic of Macedonia since independence has established social healthsystem based on the principles of mutuality, solidarity and equity. Health systemis financed predominantly with social contributions from employees, while smallerpercentage comes from the central budget. Primary objective of this organizationof the health care system is to secure full coverage to all citizens with health insuranceby spreading the burden of financing over different layers of population. Finalgoal is to protect the citizens from further private expenditures while utilizing thehealth care services.

New health policies

In approach towards the realization of these objectives, the government of theRepublic of Macedonia in 2006 has created new package of health policies. Legislativechanges were introduces including tax reforms with reduction in all socialcontributions including health contributions from 9.2% in 2006, subsequently to7.3% in 2010, to reach the target of 6% of gross salary of the employees by 2011.The idea behind these tax reforms was to decrease the costs of the labor force inorder to stimulate new job opportunities. Additional policy to improve the accessto health care was the project for free health insurance for all citizens initiated in2009. In similar direction was created the policy for unique and referent prices ofpharmaceuticals. Contrary to the expectations of the policy makers, the realizationof this reform package led in accumulation of the problems in the health caresystem and it distorted the access for health care for the population.


According to the official statistical data in the Republic of Macedonia, reduction inthe rate of health contributions had minimal effects in stimulating the employment.Furthermore, the project for free health insurance was not supported with financialcompensation for the expenditures for this group of citizens from the centralbudget to the Health insurance fund. Finally, introduction of the referent prices ofpharmaceuticals instead to increase the choice of drugs for the citizens, in practice it has increased the private expenditure for health. The combination of decreasedrevenues in the HIF, supplemented with pressure to secure increased volume ofservices put the health system towards financial instability. In order to be protectedfrom additional losses, the HIF is cornered to shift the burden for financing of thehealth care services towards the health care providers (health centers, hospitals,clinics, pharmacies, etc) by reduction of their budgets or limitation of the quotasof the positive list of drugs. Such situation is forcing the health providers to transferthe burden for financing towards the population. The citizens are exposed tohigher financial expenditures in the access to healthcare facilities and in access tobasic drugs. International experience shows that development of such policies inpractice has negative implications towards the health status of the most vulnerableand poor citizens.


Creation of health policies aimed to improve the access for healthcare servicesand to decrease the private expenditure should be supported with detailed analysesand careful system planning. Otherwise, our experiences suggest that contraryto the expectations, the effects may violate the access to the health systemfor the population and to increase the inequities in health.

Full Text:



  • There are currently no refbacks.

Copyright © 2012 Ревија за Социјална Политика.