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REPUBLIC OF MACEDONIA
HEALTH SYSTEM
-OVERVIEW AND CHALLENGESMinister of Health
Bujar Osmani, MD
SEECP Health Ministerial Meeting
“Achievements and challenges of strengthening health system performance
through addressing inequalities in health services in South Eastern
Europe”
Chisinau, 7 November, 2008
Socio Economic Indicators
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Population:
Administrative division:
Capital:
Ethnicity/languages:
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Religions:
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Literacy rate:
Unemployment rate:
GDP per capita:
Health expenditure of GDP:
2,036,855
84 municipalities
Skopje
Macedonian 64,18%, Albanian
25,17%, Turkish 4%, Roma 2%,Serb
2%, Vlachos 2%, Other 1%
Orthodox Christian 67%, Muslims 30%
94%
37%
$ 2200
6%
Health System Organization
Number of inhabitants per 1 Doctor by health
regions in Republic of Macedonia in 2006
Number of inhabitants per 1 Dentist by health
regions in Republic of Macedonia in 2006
Health Indicators
 Life
expectancy at birth:
 Natality - rate per 1000:
 Infant mortality rate:
 Maternal death per 100,000
live births:
 Mortality rate – per 1000:
73.4
11.0
12.8
11.0
9.0
The Distribution of Leading Causes for
Death

circulatory diseases
 malignant neoplasms
 respiratory diseases
 injuries
599,1 /per 100 000
265,1 /per 100 000
41,6 /per 100 000
32,9/per 100 000
Priorities of the Health System Reforms
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Improving health status
Efficacy of the health system
Providing quality of services
Strengthening public health
Planning of the human resources
Providing health quality assurance
Improving health care financing
Improving accessibility and quality of
pharmaceuticals
 E-health
Strengthening Legal Framework
-enhancing human rights in health and medicineUmbrella laws:
 Law on Health Care
 Law on Protection of
Patient Rights
 Law on Mental Health
 Law on Health
Insurance
MINISTRY OF
HEALTH
EDUCATIONAL
SYSTEM
CHAMBER
Strengthening health system financing
FACTS (main resources):
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Contributions- 97,80%
Participation-services/drugs
Budget /Public Health Programs
REFORMS (respond to the population needs):
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Basic package of services
Upgrading financing of the public health/programs
Increasing of the HIF autonomy/management of HIF
HIF-strategic purchaser of services/contracting with
the HC providers
Introducing E-Health

Informatics system in the Health Insurance Fund
 Implementation of the Hospital info systems in
the chosen hospitals /possibility to broaden up
on national level)
 Development of the unique registers( unified
code systems)
 Implementation of the info systems by the chosen
doctors in order to provide electronic information
and exchange of information
 Establishing of the E-health card
 Diagnostic related group (DRG) as a standard
system for medicinal and financial reporting
 Electronic health dossier
Investments in Health
1.
2.
3.
National efforts:
 Government has assigned 40 million euros for
purchasing new medical equipment for the state
owned health institutions
 Investments in hospital infrastructure are
decided upon /loan/
 Savings as investment (hospitals autonomy,
hospital health care management improved,
privatization in the primary level of health care)
Public-private partnerships encouraged
Foreign investments encouraged
Patient centered health care-through acknowledging the
value of providers (medical professionals)
-socio-economic effects of transition on healthcare
workforce at national level
Working conditions, healthcare services - rapid
changes
 New technologies, high demands for realization
 Loss of job, concurrence, restriction of funding,
restructuring and privatization of the healthcare
 Global health threats, migration
Frequency of workplace stress factors in Examined
and Control group of Healthcare workers
( N=250 subjects), Institute of OH, WHO CC, 2006
Stress factor
Examined
group
Control
group
p
Working with “uncritical behavior”
patients
109
(51,7%)
17
(43,6%)
0,35
Working with infectious diseases
126
(59,7%)
15
(38,5%)
0,00149
Low estimation
150
(71,1%)
26
(66,7%)
0,5807
Low opportunity for professional success
132
(62,6%)
18
(46,2%)
0,0559
Lack in work-organization
134
(63,5%)
22
(56,4%)
0,4012
THROUGHT EDUCATION – TO PATIENT SAFETY
FOR ALL
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Medical education development at all levels, in
different profiles
 Medical faculty, school of public health, faculty of
dentistry, faculty of nursing …
 3 cycles education according to bologna
declaration
 Harmonisation of curricula
 New programs, new teaching and learning
methods
 Mobility of students and teachers
 Free movement of research and scientific ideas
Thank you