A Glimpse into the Future of our Healthcare System

Access to medicines - a fundamental element of the right to health

The right to health is a constitutional right in the country, exercised through the Universal Health Coverage (UHC) provided by the public health system. Medicines are an integral part of the basic health services funded by the public budget; therefore, access to medicines is an essential component of the healthcare system's functionality.

However, in the country, patients still face challenges in accessing the latest innovative treatments, resulting in adverse effects on health outcomes and placing a significant burden on healthcare resources. According to the latest annual WAIT indicator for 2023, out of 168 newly approved medicines by the European Medicines Agency (EMA) in the period 2018-2021, only 10 became available in North Macedonia. This places the country at the bottom among the 37 European countries included in the survey. In addition, the World Health Organization (WHO) reports that out-of-pocket payments in the country exceed 40% of the total health spending, with approximately 80% allocated to medicines.

The reasons for insufficient access are multifaceted and include the absence of an updated reimbursement list, a situation that is expected to improve soon as the process has recently been restarted. Other factors contributing to the issue include inadequate planning of hospital medicines, which does not align with actual needs, slow tender procedures that do not account for healthcare specificities, a lack of innovative payment mechanisms, insufficient communication and collaboration among different bodies, and a lack of patient involvement in decision-making.

The discussion on this topic will begin with a presentation of data analysis by IQVIA, illustrating the access gaps in terms of medicines that are registered and funded through various mechanisms (reimbursement, conditional budgets, MoH programs) in the country, in comparison with the EU and countries in the region. The panel will feature representatives from both the government and the private sector with the objective of discussing the challenges and potential ways forward.

State of secondary use of health data and policy recommendations

Data is essential for healthcare system planning, resource allocation, and policy creation. One of the problems consistently identified as the main obstacle to inadequate policies and inefficiencies in the Macedonian healthcare system is the lack of quality data, ongoing data gathering and processing, digitalization processes, data transparency, and the fragmentation of existing data among different institutions.

In North Macedonia, health data related to population health, outcomes, treatment, services, and spending is gathered through various sources and systems, including the MojTermin information system, the Health Insurance Fund (HIF), the Institute for Public Health, the State Statistical Office, and the Ministry of Health, among others. Most of the data is collected and processed for the primary purpose of planning and delivering healthcare. The MojTermin system, in particular, is well-developed in this segment. However, a significant challenge lies in the secondary use of health data. Secondary use is defined as the utilization of data for purposes other than the primary one, particularly in research, innovation, public health, policy-making, regulatory activities, personalized medicine, and similar endeavors. Given the European Union's increased focus on healthcare in recent years, this topic is gaining prominence. The EU is actively working on several initiatives, primarily the creation of the European Health Data Space, and the corresponding regulatory framework to enable the sharing and utilization of health data while respecting privacy rights and ethical considerations.

The aim of this session is to explore the current status of secondary use in Macedonia, its regulation, practical implementation, challenges, and recommendations. The discussion on this topic will be based on the country report by ODI, which will be presented.

At a turning point: North Macedonia healthcare system

The healthcare system in North Macedonia is at a crossroads, facing a multitude of pressing challenges. From navigating the complexities of the COVID-19 crisis to addressing the ongoing shortage of healthcare professionals, the transfer of medical staff from the public to the private sector, inefficiencies in resource planning and allocation, inadequate funding, the lack of comprehensive data and digitalization of processes, inefficient institutions, the absence of evidence-based policy-making, a scarcity of patient-centric approaches, and the absence of meaningful involvement of all relevant stakeholders, including the private sector, in policy-making.

Addressing these issues demands resolute reform, strong commitment, and a fundamental shift in mindset. It's imperative to take concrete steps creating a patient-centric, data-driven, quality-focused healthcare system.

As governments worldwide struggle with the intersection of population health and economic uncertainty, we must understand the differences and commonalities in healthcare financing and policies. A report by AmCham EU Healthcare Committee and Economist Impact benchmarks healthcare services, medicines, outcomes, and quality of care. Furthermore, it offers a range of recommendations for action in crucial areas such as financing models, care delivery, access to innovative treatments, diagnostics, and digital infrastructure.

In this discussion, key political parties in North Macedonia will share their perspectives and insights on the main aspects highlighted in the report. This session aims to explore the current healthcare landscape in North Macedonia, the challenges it faces, and the necessary steps for its transformation, shaping the future of healthcare.