Catastrophic Health Expenditures in Republic of Macedonia - Are We Equal?

Republic of Macedonia has a population of 2.045.177 and per capita GDP of USD 8.200 (PPP). Statistical Yearbook from 2006 reports unemployment rate of about 37%, poverty is estimated to be 21.7% while 50% of Macedonians are considered as poor, which all contributes that the population has difficulties in co-payments in healthcare provision. No exact data is available on out-of-pocket (OOP) patient payments, but there is some evidence that it takes significant place in public facilities and should be monitored closely.

Data obtained with the Household Consumption Survey in the Republic of Macedonia conducted in the period 2003 - 2007 were used for analysis of catastrophic health expenditures, using WHO methodology.

The sample size of the households surveyed each year is 5040 households, 1% of the total number of all households around the country.

Results show that average OOP for health services has increased in the analyzed period, from an average of 10.770 MKD in 2003 to 11.650 MKD in 2007; in addition, poorest population in 1^st-5^th decile of income pay significantly more and the difference is statistically significant.

Protecting the population against financial poverty from key medical expenses that consume a large share of household income is an important yet neglected policy concern in the health sector. The costs of medical care generate financial risks, in addition to income losses due to impaired labour supply and productivity. Reliance on OOP financing of health care in developing countries leaves households exposed to the risk of unforeseen medical expenditures, while illness can result in a difficult choice between diverting resources towards medical care with the risk of long-term deterioration in health and earnings capacity.