Milevska Kostova Neda, Chichevalieva Snezhana, Ponce Ninez A, van Ginneken Ewout, Winkelmann Juliane
Centre for Regional Policy Research and Cooperation Studiorum.
National Health Policies Programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe.
Health Syst Transit. 2017 May;19(3):1-160.
This analysis of the health system of the former Yugoslav Republic of Macedonia reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The country has made important progress during its transition from a socialist system to a market-based system, particularly in reforming the organization, financing and delivery of health care and establishing a mix of private and public providers. Though total health care expenditure has risen in absolute terms in recent decades, it has consistently fallen as share of GDP, and high levels of private health expenditure remain. Despite this, the health of the population has improved over the last decades, with life expectancy and mortality rates for both adults and children reaching similar levels to those in ex-communist EU countries, though death rates caused by unhealthy behaviour remain high. Inheriting a large health infrastructure, good public health services and well-distributed health service coverage after independence in 1991, the country re-built a social health insurance system with a broad benefit package. Primary care providers were privatized and new private hospitals were allowed to enter the market. In recent years, the country reformed the organization of care delivery to better incorporate both public and private providers in an integrated system. Significant efficiency gains were reached with a pioneering health information system that has reduced waiting times and led to a better coordination of care. This multi-modular e-health system has the potential to further reduce existing inefficiencies and to generate evidence for assessment and research. Despite this progress, satisfaction with health care delivery is very mixed with low satisfaction levels with public providers. The public hospital sector in particular is characterized by inefficient organization, financing and provision of health care; and many professionals move to other countries and to the private sector. Future challenges include sustainable planning and management of human resources as well as enhancing quality and efficiency of care through reform of hospital financing and organization.
对前南斯拉夫的马其顿共和国卫生系统的这一分析回顾了组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的近期发展情况。该国在从社会主义体系向市场经济体系转型过程中取得了重大进展，尤其是在医疗保健的组织、筹资和提供方面进行了改革，并建立了公私医疗服务提供者并存的格局。尽管近几十年来医疗保健总支出的绝对数额有所增加，但占国内生产总值的比例却持续下降，而且私人卫生支出仍处于较高水平。尽管如此，过去几十年中该国人口健康状况有所改善，成人和儿童的预期寿命及死亡率与前共产主义欧盟国家相近，不过因不健康行为导致的死亡率依然很高。1991年独立后，该国继承了庞大的卫生基础设施、良好的公共卫生服务及分布广泛的卫生服务覆盖范围，并重建了一个福利优厚的社会医疗保险体系。基层医疗服务提供者实现了私有化，新的私立医院也被允许进入市场。近年来，该国对医疗服务提供的组织进行了改革，以便在一个综合体系中更好地整合公立和私立医疗服务提供者。通过一个开创性的卫生信息系统实现了显著的效率提升，该系统减少了候诊时间，使医疗服务的协调更加顺畅。这个多模块电子卫生系统有可能进一步减少现有的低效率现象，并为评估和研究提供依据。尽管取得了这些进展，但对医疗服务提供的满意度参差不齐，对公立医疗服务提供者的满意度较低。特别是公立医院部门存在着医疗保健组织、筹资和提供效率低下的问题；许多专业人员流向其他国家和私营部门。未来的挑战包括人力资源的可持续规划和管理，以及通过改革医院筹资和组织来提高医疗服务质量和效率。
