Primary health care financing in North Macedonia: a situation assessment and policy considerations

Overview

Primary health care (PHC) in North Macedonia is delivered through a mix of private “chosen doctors”, who mainly operate in solo practices, and publicly owned Health Homes. However, overlapping roles and limited coordination persist. While consultations are free, out-of-pocket payments for medicines burden households. PHC funding remains low and existing provider payment mechanisms provide limited incentives for quality or coordination. Strengthening PHC requires reducing fragmentation between chosen doctors and Health Homes and moving toward multidisciplinary, team-based models of care. A national vision should clearly define the scope and roles of PHC providers, supported by modern infrastructure, updated workforce standards and the greater use of nurses. Expanding the PHC benefits package in line with clinical guidelines, while reducing co-payments for medicines and diagnostics, will ensure more affordable access. Short-term improvements to PHC payments for chosen doctors could include bonuses for the family medicine specialization, updated capitation adjustments and revised performance payments linked to quality. A critical reform priority for the Health Homes is to ensure that a portion of financing is tied to actual service delivery outputs. Over the medium term, a blended payment model for PHC providers, coupled with stronger contracting and performance monitoring, can incentivize coordination and quality.