Running Head: Leadership Framework in Public Health 1

Assessment 2. Case Summary

Student’s Name: Kevin-Jay Ovejera

Student ID #: 00258734T

Institution of Affiliation: Torrens University

Date:

Worde count:
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Case summary: The Republic of Macedonia: Health Systems and Economics

The former Yugoslav Republic of Macedonia is a landlocked country situated in south-

eastern Europe on the Balkan Peninsula. It has a total population of 2.1 million, with a mixed

ethnic, religious and cultural composition. The country’s GDP for healthcare is 8.5% as of 2015.

There are different methods the country used in generating funds. (1) compulsory insurance

contributions (wage-based contributions), (2) transfers from the central budget (general taxation)

and other agencies , (3) out of pocket expenditures directly paid by the citizens.

The legislative power of the Health system is presented by:

1. The Governance and The Parliament- adoption of legislation, state budget, the budget

of the HIF.

2. The Ministry of Health- develop legislation, policies, regulations and standards.

3. The Ministry of Finance- approves the HIF budget (with regards to expenditures on a

yearly basis).

4. The HIF- the main purchaser of health services in the country.

5. The Institute of Public Health- health promotion through monitoring and research.

6. The State Sanitary and Health Inspectorate.

7. Agency for Medicines and Medical devices.

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Efficiency

With the aim of providing incentives to improve the efficiency and quality of health services
covered by the HIF, the Ministry of Health introduced P4P in 2012 to remunerate physicians and
to move away from fixed salaries P4P is based on mandatory reporting of each procedure that
physicians perform in a specially developed web-based application. Data are analysed at
provider level for the purposes of comparison, control and payment of providers. The central
database is housed at the Ministry of Health. The system measures individual physician’s
performance (in terms of output) as reported by doctors.
UNIVERSAL HEALTH COVERAGE (UHC) in Macedonia goal is to have Equal access to

care, increase Quality of healthcare services and Financial protection. Citizens of Macedonia,

Registered long term residents are covered with the Universal health. They are covered from

Visit to GPs, Medicines listed under HIF, Specialist referrals, postnatal home visits for

newborns, immunization and health check-ups of school children, Treatment of rare diseases like

tuberculosis and HIV prevention and control and other public health services and more.

The strenght of this UHC it has significant efficiency and has improved health outcome.

However, there is a problem in the financing and organisation and not to mention the

management of human resources. That is why, it is to be recommended that there should be

involvement of civil society and patients in its Governance Board of Health Insurance Fund,

their influence on decision-making is still small. Hence, the public should get chance to involve

in decision making process in the health sector, then it will help to use the resources as per need

and priority. The frequent and inconsistent changes in key legislation without updating and

publication of the revised text, as well as the overlapping of responsibilities of the institutions

often lead to confusion and inappropriate use of them. There should be clear and consistent

legislation to provide preventive health care, with clearly defined responsibilities for operations
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and monitoring of the provided services (Kamcev, N., Angelovska, B., Kamceva, G., & Richter,

K., 2010). Medical institution need to be set up focusing on rural areas to increase the

manpower.

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