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SUMMARY
VOLUNTARY HEALTH INSURANCE – ADDITIONAL LEVER FOR
IMPROVING QUALITY OF HEALTH SERVICES
Мetodije Trajanovski 1
1 Faculty of Public Health
Medical University, Sofia,
Despite the fact that membership of HIF is in essence mandatory, it is estimated
that some people in Macedonia do not have health insurance. It is thought that many of
these people are in the higher income group, perhaps self employed, who ‗self insure‘ and
pay for healthcare directly to providers out-of-pocket. Despite the law which stipulates
the right of the population to a broad range of healthcare benefits, the community seems
to be of the view that in practice, these entitlements are difficult to access. People
contribute a quite significant proportion to healthcare costs through out-of-pocket
payments. These out-of-pocket payments take the form of co-payments, unofficial
payments, payments for services that are listed in the statutory package but are not
available, or services that are outside the existing benefits package. According to the
information presented in Tables 1 and 2 therefore, the combined HIF and out-of-pocket
expenditure on healthcare therefore is approximately MKD18.2 billion of which, the outof
pocket expenditure is some 25%, which is a relatively high figure when compared to
most western European countries. The right direction of the health reforms is to find the