North Macedonia: Health System Review.

This analysis of North Macedonia's health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Life expectancy improved prior to the COVID-19 pandemic, but remains far below the EU average, and the country still struggles with comparatively high levels of morbidity and mor¬tality. The social health insurance system covers almost the entire population and progress has been achieved in providing access to publicly covered essential health services. However, challenges remain for patients in access¬ing health services and in financial protection. Geographical accessibility of services varies, with better access in the capital and major cities compared to smaller towns and rural areas. In terms of health financing, the health system offers universal population coverage for a wide range of benefits and services, which are free at the point of delivery or require only minimal co-payments to prevent overuse. Yet the share of private spending on health as a percentage of current health expenditure is high, which undermines the achievement of key health system goals, such as financial protection, equity and efficiency. The health workforce has been a focus of health reforms and efforts are underway to strengthen education and training to improve the skill mix and competences of the health workforce to respond to new challenges and an ageing population. The ratio of physicians per population has increased markedly in recent years, but remains below the EU average. The priorities for the country in the National Health Strategy 2021-2030 are restructuring the hospital system, continuing the country's primary care reform, and improving quality of care while increasing the efficiency of resource use. Access to medicines has improved, but further efforts are needed to ensure access to innovative medicines and treatments. Overall, the Macedonian health system has made important progress, especially in terms of digitalization of health care and access to e-services and telemedicine, but unmet needs remain an issue. The main outstanding challenges include increasing the responsiveness of the health system to population needs; redistributing resources and activities from hospitals to primary care; ensuring access to medicines; and safeguarding the financial sustainability of the health system.