Health care in Macedonia
After the declaration of independence in September 1991, the newly established Macedonian state inherited a healthcare system which was already developed by the communist regime of Yugoslavia. Before world war II poor nutrition and infectious diseases in the region were reason for some of the highest death rates in Europe. During the period of socialism (1945-1990) health care availability rapidly improved, while all health institutions were nationalized, medical services became free of charge and the healthcare system went through deep reforms.
Today, the healthcare system in the Former Yugoslav Republic of Macedonia is developing fast to meet modern health standards, constantly improving the quality of the health services and fighting many of the issues yet to be solved: corruption of medics, the lack of specific medical treatment centers in public hospitals: cardiosurgery is available only in private hospitals, for example. The healthcare system is funded by compulsory health insurance which is paid by the employers and out-of-pocket payments.
In recent years the health insurance taxes have been lowered, but because of the high unemployment rate of over 30%, a large number of the citizens of Macedonia are uninsured. There are more than enough experts in certain medical specialties and some procedures are times cheaper than in the rest of the world – Macedonia could be a destination for Dental tourism like other Balkan countries. However, there are no specialists capable of treating some diseases and of performing complex procedures like brain or spinal surgery.
In Macedonian culture health is considered to be one of the most important things in life. The Improvement of the quality of the healthcare services in Macedonia is a priority in the strategy for development of the ministry of health of Macedonia. The government is working for the establishment of a network of Cardiology centers, specialized departments for patients who have been in a coma for long periods, the promotion of organ and tissue transplantation and is working for the overall improvement of the efficiency of the healthcare services.
Macedonia is in the European region of the World Health Organization, which has an office in the country since 1996 and is advising the government on reforms and improvement of the access to health services. Besides the WHO, the Macedonian ministry of health is working in cooperation with other international organizations, including the United Nations Development Programme and UNICEF. A national health strategy for 2020 has been developed with the slogan: “For a safe, just and efficient healthcare system”.
Medical Education in Macedonia
The educational institutions who train physicians in most medical specialties in Macedonia are the medical faculties of some of the larger universities. The first medical faculty in Macedonia was established in 1947 in Skopie as part of the St. Cyril and St. Methodius university. At the time there was an insufficient number of physicians in the region, while the medical universities of Yugoslavia weren’t capable of providing enough new medical specialists.
The faculty of medicine at Ss. Cyril and and Methodius university offers high quality education with its over 70 years of experience in teaching a wide range of medical specialties, including: General Medicine, Radiology, Nursing and Physiotherapy in educational programs of 6 years. A large number of the general practicing doctors in Macedonia are trained here and in the newly established medical faculty of the University of Shtip. Since 2008 it is providing education in General Medicine, Pharmacology, Dentistry, Nursing and a number of sub-specialties.
There is no system for the accreditation of the physicians in Macedonia and this is one of the issues of the medical students, being a reason a reason their diplomas to not be internationally accepted. Since Macedonia is has one of the highest unemployment rates in the world, with over the medical students are facing a lot of difficulties when starting their career.
Unlike the 1940’s, today there is a high interest in medical studies in the country, but the students graduating the medical faculties are more than are actually needed in the hospitals and this leaves a lot of unemployed doctors, forcing them to further specialize and work abroad. Many Macedonian students choose education and a career in neighboring countries.
The high levels of corruption which are typical for every post-socialist country have affected the healthcare system as well. All insured individuals in Macedonia have the right some free and cheaper procedures but many times they are forced to bribe the medics in order to get admitted for treatment.
Among the priorities of the Ministry of health is the improvement of healthcare and health of the society through preventive healthcare and education about its importance – patients usually seek medical attention only after a disease has developed. While obesity is not a significant risk factor like in the US and other Western countries, the greatest health risks and causes of life-threatening diseases are Alcohol and Tobacco and although the percent of smokers is lower than in neighboring countries (Serbia, Bulgaria and Greece are the countries with the highest percentage of smokers, with Greece being #1 in the list), 50% of high school students in Macedonia have smoked and 23.9% of the people over the age of 15 smoke actively.
Macedonia is losing the fight against lung cancer – it is the most common cancer among men with about 800 new cases each year and increasing. There is only one Oncology center in the country which has the equipment required to treat cancer and it has the capacity of operating only 150 patients with lung cancer a year. The University Clinic of Radiotherapy and Oncology in Skopje is serving the entire population of 2.1 million people in the small country. The most common cancer in women is breast cancer – the Ministry of health of Macedonia is working on promoting regular examinations for the purpose of early diagnosis, which is the key to a successful treatment. Cancer mortality is higher than in Europe, with the highest number of skin cancer deaths in the Old continent.