1. REPUBLIC OF MACEDONIA HEALTH SYSTEM -OVERVIEW AND CHALLENGES- Minister of Health Bujar 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

2. 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 %

3. Health System Organization

5. Number of inhabitants per 1 Doctor by health regions in Republic of Macedonia in 2006

6. Number of inhabitants per 1 Dentist by health regions in Republic of Macedonia in 2006

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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 encouraged 3. Foreign investments encouraged

14. 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

15. Stress factorExamined group Control group p Working with “uncritical behavior” patients 109 (51,7%) 17 (43,6%) 0,35 Working with infectious diseases126 (59,7%) 15 (38,5%) 0,00149 Low estimation150 (71,1%) 26 (66,7%) 0,5807 Low opportunity for professional success132 (62,6%) 18 (46,2%) 0,0559 Lack in work-organization134 (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

16. 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

17. Thank you