REPUBLIC OF MACEDONIAHEALTH SYSTEM

-OVERVIEW AND CHALLENGES-

Minister of HealthBujar 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

Population: 2,036,855 Administrative division: 84 municipalities Capital: Skopje Ethnicity/languages: Macedonian 64,18%, Albanian

25,17%, Turkish 4%, Roma 2%,Serb 2%, Vlachos 2%, Other 1%

Religions: Orthodox Christian 67%, Muslims 30% Literacy rate: 94% Unemployment rate: 37% GDP per capita: $ 2200 Health expenditure of GDP: 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: 73.4 Natality - rate per 1000: 11.0 Infant mortality rate: 12.8 Maternal death per 100,000

live births: 11.0 Mortality rate – per 1000: 9.0

The Distribution of Leading Causes for Death

circulatory diseases 599,1 /per 100 000 malignant neoplasms 265,1 /per 100

000 respiratory diseases 41,6 /per 100 000 injuries 32,9/per 100

000

Priorities of the Health System Reforms

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 medicine-

Umbrella laws: Law on Health Care Law on Protection of

Patient Rights Law on Mental Health Law on Health

Insurance

MINISTRY OF HEALTH

CHAMBER

EDUCATIONAL SYSTEM

Strengthening health system financing

FACTS (main resources): Contributions- 97,80% Participation-services/drugs Budget /Public Health Programs

REFORMS (respond to the population needs): 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. 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)

2. Public-private partnerships encouraged3. 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

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

Frequency of workplace stress factors in Examined and Control group of Healthcare workers ( N=250 subjects), Institute of OH, WHO CC, 2006

THROUGHT EDUCATION – TO PATIENT SAFETY FOR ALL

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