Can people afford to pay for health care? New evidence on financial protection in North Macedonia

Overview

This review is part of a series of country-based studies generating new evidence on financial protection in health systems in Europe. Financial protection is central to universal health coverage and a core dimension of health system performance.

Although access and financial protection have improved in North Macedonia in recent years, catastrophic health spending remains a problem, particularly for poorer households, and is largely driven by out-of-pocket payments for outpatient medicines.

To improve access and financial protection, the health system should:

• de-link entitlement from payment of contributions for the whole population, so that access to health care no longer depends on health insurance status;
• simplify the complex design of user charges and strengthen protection against co-payments for outpatient medicines;
• improve the affordability of outpatient prescribed medicines by enhancing the selection and purchasing of medicines and regularly updating the positive list;
• address informal payments, starting with better monitoring; and
• increase public investment in the health system through sustained rises in the priority given to health in allocating government spending.