Two Years of Reforms That Delivered Measurable Results for Patients

The Health Insurance Fund of the Republic of North Macedonia today presented an account of the work carried out over the past two years – a period in which significant reforms were implemented, record investments in health care were secured and policies were introduced that directly improve citizens’ access to health services.

Compared with the end of 2023, the Fund secured 8,6 billion denars more for the health system, with total funds increasing from 42,9 to 51,5 billion denars, namely by 20 per cent. At the same time, the share of the health budget in GDP increased from 4,80% to 4,95%.

The largest investment in primary health care to date

In April 2025, the largest increase in the capitation point in the Fund’s recent history was implemented.

• capitation for general medicine and gynaecology increased from 75 to 100 denars (+33%);
• for dentistry from 61 to 75 denars (+23%).

This measure is worth around 1,1 billion denars annually, and total capitation has increased by more than 900 million denars, namely 21 per cent.

In parallel, new preventive targets were introduced for family doctors – early detection of prostate and colon cancer, mental health screening and expanded preventive examinations for children.

Higher salaries for health workers

In the past period, salaries in public health care were increased in three successive steps:

• 10% in November 2024;
• 5% in March 2025, following the Agreement reached with the trade unions;
• 6% in March 2026.

This achieved a cumulative nominal growth of 22,4 per cent, namely around 16 per cent real growth above inflation.

Record funds for hospitals and modern therapies

Funds for public health institutions have increased from 26,2 to 32,5 billion denars (+23,8%), while funds for university clinics increased by 32,8 per cent.

In 2025, record conditional budgets of 4,82 billion denarswere also secured, representing growth of 38 per cent in just one year.

Of these:

• 4,4 billion denars are intended for modern and innovative medicines;
• 2,4 billion denars for oncology therapy;
• 1,36 billion denars for the treatment of childhood diseases.

These funds enable the introduction of new interventions and modern therapies without an additional financial burden for patients.

At the same time, the number of hospital services provided continued to grow. During this period, 194.230 hospital cases under DRGwere delivered, representing growth of 5,1 per cent, while cardiac surgery interventions increased by 15 per cent.

The Positive List finally began to expand

After more than a decade of stagnation, a substantive expansion of the Positive List began.

Over the past 15 months , 13 new medicineshave been introduced, including anticoagulant, cardiovascular, depression and dementia therapies, as well as modern oncology medicines, with an additional budget of 5 million euros.

At the same time, through generic competition, the reference price of the inhalation therapy beclometasone/formoterol was reduced from 2.715 to 1.915 denars, thereby ensuring annual savings of around 46–49 million denars, funds that are reallocated to finance a new modern medicine.

In the interest of patients, two oncology medicines were transferred to the primary Positive List, thereby avoiding around 11.000 unnecessary journeys and specialist examinations annually solely for prescribing a prescription.

Faster and broader access to treatment

In the area of treatment abroad:

• 290 treatmentswere carried out, representing growth of 19 per cent;
• rejected applications decreased by 61 per cent;
• the decision-making period was shortened from 45 to 30 days.

Rights to biomedical assisted fertilisation were also significantly expanded, with the number of attempts increasing from three to six, and the procedure was fully simplified.

In addition:

• the number of users of medical rehabilitation increased by 7,6 per cent;
• dialysis treatments increased by 5 per cent, with the introduction of two new modern methods.

The Fund – an institution in the service of citizens

The Fund is today ranked as the most transparent institution in the country, representing a huge leap from 45th place in 2024.

At the same time, the institution today serves 465 more contracted health institutions, and does so with 29 fewer employees, while the number of inspections has increased significantly, especially for sick leave, where twice as many inspections have been carried out.

Acknowledgement

The results achieved are the product of joint work, dedication and partnership.

Special thanks are due to all employees of the Fund – in the Central Service and in the regional services throughout the country. With fewer staff and a significantly greater volume of work, they demonstrate every day that public administration can be efficient, professional, responsible and fully committed to citizens.

We also express our thanks to health workers in public and private health institutions, to the Ministry of Health and the Government for their partnership in implementing the reforms, to the trade unions for constructive social dialogue, to family doctors, pharmacies and contracted health institutions that are closest to patients every day, as well as to the media, whose questions and professional approach contribute to making institutions even more open, transparent and accountable.

The greatest thanks belong to insured persons and patients. Their trust is the greatest recognition of our work, but also the greatest obligation that we bear.

Press statement by the Director of the Fund, Mr Sasho Klekovski: