Health Insurance Fund of North Macedonia

FZOM logo

Health Insurance Fund of North Macedonia (Fond za zdravstveno osiguruvanje na Severna Makedonija) is the primary public health insurance institution in North Macedonia, responsible for the provision of healthcare services to its citizens. Established to ensure the accessibility, quality, and efficiency of healthcare services, the Fund plays a crucial role in the country's healthcare system.

Overview

The Health Insurance Fund of North Macedonia operates under the principles of solidarity and universality, ensuring that all registered citizens and residents have access to healthcare services. It is funded through contributions from both employers and employees, as well as from the state budget for unemployed, children, and other vulnerable groups.

Services Covered

The Fund covers a wide range of healthcare services, including:

• Primary healthcare
• Specialist consultations
• Hospital care
• Prescription medications
• Preventive services
• Rehabilitation
• Emergency healthcare services

Patients are required to choose a primary care doctor who acts as the gatekeeper to other services. Referrals from primary care physicians are typically needed to access specialist care.

Eligibility and Contributions

Eligibility for coverage under the Health Insurance Fund is tied to legal residence in North Macedonia and participation in the social security system. Contributions are determined as a percentage of the individual's salary, with rates set by the government. Self-employed individuals and employers are also required to contribute to the fund on behalf of their employees.

Challenges and Reforms

The Health Insurance Fund of North Macedonia faces several challenges, including financial sustainability, ensuring equal access to high-quality services, and adapting to the changing healthcare needs of the population. In response, the government and the Fund have initiated various reforms aimed at improving efficiency, reducing costs, and enhancing the quality of care.

Governance

The Fund is overseen by a board of directors, which includes representatives from the government, employers, employees, and healthcare providers. This governance structure is designed to ensure that the interests of all stakeholders are represented in the management of the Fund.

Future Directions

The Health Insurance Fund of North Macedonia is continually evolving to meet the healthcare needs of its population. Future directions include the integration of digital health technologies, improving preventive care, and further reforms to enhance the sustainability and effectiveness of the healthcare system.