4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
The Ministry of Health and the Health Insurance Fund initially reallocated funds at their disposal from existing budgets. Within the Ministry of Health there was a transfer of funds from other preventive programmes to the COVID-19 response, to enable the procurement of medical materials and equipment.
By April the Health Insurance Fund had allocated almost EUR 1.3 million so far to the most affected public health institutions (the Clinic for Infectious Diseases, the Institute for Public Health, the Centres for Public Health, the City General Hospital Skopje etc.). However, the needs of the frontline healthcare providers were constantly increasing and the Health Insurance Fund was in the process of allocating additional resources to providers.
Legally binding decrees were adopted by the Government in the current emergency situation related to health services to patients suffering from COVID-19. The decrees meant that private health institutions outside the publicly funded network of health institutions that provide intensive care and therapy would perform this activity within the approved network of health facilities and would be able to receive referred patients. Another decree allowed health institutions outside the network to perform the laboratory test for COVID-19 in order to increase the country capacity for testing. The Health Insurance Fund contracted the private institutions that will be included in the response and determined the scope and type of health services that the private health care institution were allowed to provide. The services of these private providers was covered by the Health Insurance Fund.
External donors quickly expressed their readiness to support the country. The EU expressed interest to provide support that can be both immediate and longer-term, through the re-programming of up to €4 million into an emergency programme to cover the costs for procurement of the most urgent supplies and equipment for the treatment of patients.
The EU granted North Macedonia access to the European Solidarity Fund - the country will participate in the mutual procurement procedures of equipment and materials with the EU member states.
On 28 March, Germany offered support to the Ministry of Health with an amount of USD 2 million and USAID offered support to WHO and UNICEF operations up to a volume of USD 1.1 million from COVID-19 emergency funding. Various countries subsequently donated tests, protective equipment and funding, including China, Germany, Bulgaria, Slovenia, Hungary, Turkey, Sweden, the EU and the United States. U.S. companies like Coca Cola, Microsoft and others also offered assistance to North Macedonia for COVID-19 crisis management. Various UN agencies have also supported the country, including WHO, UNOPS, UNDP. USAID has supported both WHO and UNICEF with USD 1.1. million in their efforts to fight the epidemic in North Macedonia.
A Ministry of Health Solidarity Fund has been established. Companies, individuals, organizations, institutions, and embassies donated over 90 million denars to the account of the Ministry of Health, including donations of medical devices, protective equipment and other materials. The Ministry of Health is using this fund to procure medical equipment including intensive care beds, ventilators and infusion pumps.
The National Annual Program for Public Health was amended and additional funds in the amount of 22 million denars were allocated in the section for emergency and crisis situations to cover the activities implemented by the 10 Centers for Public Health during the period from the beginning of the crisis situation up to 20 May 2020.
On 20 October 2020, the Minister of Health announced that 16 mobile COVID centers would be built with a loan from the World Bank, as part of the funds of the so-called rapid loan of the World Bank. In addition, as part of the World Bank support, several hospitals, such as Tetovo, Ohrid and Strumica, will be equipped with relevant equipment.
Donations are continuing to arrive. On 30 October, NATO delivered 60 ventilators as part of the Alliance’s support to Allies to cope with the COVID-19 pandemic, which will be distributed to local hospitals.