Heath systems in transition. The former Yugoslav Republic of Macedonia

Since independence, The former Yugoslav Republic of Macedonia has embarked on a number of reform initiatives in the field of health care. All reform initiatives are undertaken with the aim of sustaining access for the whole population to a comprehensive health system, as well as improving the quality of health services and enhancing financial sustainability. A number of reforms have been very successful and have brought about positive changes in the health sector. At present the system is facing a number of challenges, however, including the need to overcome the legacies of the health system that was in place until 1991. These challenges include: strengthening of human resources planning and training, including the reduction of the oversupply of staff, especially in the PHC sector; strengthening of continuing medical education; and introducing admission quota to training facilities. Moreover, the health care facilities need to be rationalized in order to redistribute limited resources more effectively and thereby to improve the infrastructure of facilities, as well as the quality especially of PHC services. The reorganization of medical centres at primary care level, privatization trends and reforms regarding the remuneration of providers – with the introduction of a capitation-based system at primary care level and an annual global budget allocation for inpatient care – represent important developments in this field.