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Methodological explanation for the news release:

Health Accounts

This methodological explanation refers to the data published on health accounts, prepared in accordance with the internationally comparable methodology A System of Health accounts, 2011- SHA (System of Health Accounts), accepted by the OECD, Eurostat and WHO. The calculations use a bottom up method of estimation (assessment) which provides comprehensive access and aggregation of data from lower to higher level.

Legal basis

The legal basis for processing, preparation and dissemination of data on health accounts is the Law on State Statistics ("Official Gazette of the Republic of Macedonia No. 54/97, 21/07, 51/11, 104/13, 42/14, 192/15, 27/16, 83/18 and 220/18 and Official Gazette of the Republic of NorthMacedonia No. 31/20), as well as the Five-Year Statistical Program 2018-2022 ("Official Gazette of the Republic of North Macedonia No. 18/20 and 300/20).

Observation units

Observation units are all providers of different health services in the observed calendar year.


 The data covers the total expenditure of the population of RNM for performed health services, issued medicines and medical technical aids according to the SHA methodology. Public, private and donated funds are included.

Data sources

 Data from administrative sources and statistical surveys are used for the calculations. The main sources are data collected by the Health Insurance Fund of the Republic of North Macedonia, annual financial reports of ministries and the Central Register of RNM, from statistical surveys conducted by the Ministry of Labor and Social Policy, the Ministry of Defense, the Ministry of Finance and other relevant institutions.


 The basic tables show the total expenditure of residents of RNM costs incurred in health care according to ICHA (International Classification of Health Accounts) and includes three dimensions of costs according to:


• Health care functions (functional classification) (ICHA-HC),

 • Health Care Providers (ICHA-HP) and

• Expenditures of Health Care Financing Schemes (ICHA-HF).

Description of the categories


1.      ICHA-HC Classification of health care functions

HC 1. Curative care- includes health services aimed at reducing the symptoms of illness / injury, preventing complications and healing, including diagnostic and therapeutic procedures, surgery and obstetrics (excluding rehabilitation and palliative care)

HC 2. Rehabilitative care - includes health services aimed at improving the function of a     patient with functional disabilities due to illness or injury.

HC 3. Long-term care (health)- includes long-term health care for a patient with chronic diseases and reduced functional abilities.

HC 4. Ancillary services (specified by function) - includes clinical laboratory, diagnostic imaging, emergency care, and patient transportation; applies only to patients who are not hospitalised.

HC 5. Medical goods (specified by function)- includes retail sale of prescription and non-prescription drugs, consumable medical products, glasses and other optical aids, hearing aids, orthopedic aids.

HC 6. Preventive care - includes information-related prevention services, education and counseling, vaccination programs, early detection programs, health screening programs, epidemiological surveillance, risk and disease control programs, and emergency and disaster preparedness programs.

HC 7. Governance, and health system and financing administration - includes planning and implementation of health policy, plans, programs and budgets, preparation and implementation of legislation and standards related to health, collection, processing and dissemination of information, technical documentation and statistics on health, administration of Health Insurance Fund and private health insurance.


2.      ICHA-HP Classification of health care providers

HP 1. Hospitals - includes clinics, general and special hospitals.

HP 2. Residential long-term care facilities - Includes homes for the elderly and infirm and homes for the mentally ill adults

HP 3. Providers of ambulatory health care - includes all independent practices of physicians, dentists, and other health care providers. staff, health centers, independent clinics, institutions and independent practices for physical therapy and rehabilitation and home care.

HP 4. Providers of ancillary services - includes laboratories, Institute of Transfusion Medicine, institutes of emergency medicine, institutions of medical transport.

HP 5. Retailers and Other providers of medical goods - includes pharmacies, retail of optical, hearing and / or orthopedic devices and medical devices.

HP 6. Providers of preventive care - includes public health institutes and organizations that implement public health programs.

HP 7. Providers of health care system administration and financing - includes the Ministry of Health and the agencies and institutions under its jurisdiction (except those explicitly listed in other categories), the Ministry of Defense, the Ministry of Justice, local self-government and health insurance.

HP 8. Rest of economy - includes other health care facilities as a secondary activity and as home health services.

HP 9. Rest of the world


3. ICHA-HF Classification of health care financiers:

HF.1 Government schemes and compulsory contributory health care financing schemes

HF. 1.1 Government schemes - includes units of state administration and self-government at state and local level.

HF. 1.2 Compulsory contributory health insurance schemes - includes Health Insurance Fund for compulsory health insurance.

HF. 2 Voluntary health care payment schemes

HF. 2.1 Voluntary health insurance schemes - includes additional HF insurance and other private insurance.

HF. 2.2 NPISH financing schemes (including development agencies) - includes foundations and associations with health costs.

HF. 2.3 Enterprise financing schemes- includes data on the cost of systematic inspections paid by enterprises.

HF. 3 Household out-of-pocket payment - includes an estimate of "Private costs without co-payment" and is based on the so-called residual method. For 2017 and 2018 it includes the export of services.

HF. 3.1 Out-of-pocket excluding cost-sharing

HF. 3.2 Cost sharing with third-party payers


Last updated: 19.02.2021


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