In its latest 2026 report on North Macedonia’s progress, the European Commission lists insufficient public healthcare funding, the departure of medical staff, unequal access to services and weak enforcement of smoking restrictions indoors among the main problems.
The assessment of consumer protection and public health in Chapter 28 shows that the healthcare system still faces serious structural challenges. Citizens pay out of pocket for up to 42 percent of healthcare costs, creating a significant barrier to equal access to care.
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According to the Commission, public healthcare funding rose slightly in 2025, but remains well below the EU average. The system relies heavily on direct payments by citizens and voluntary health insurance, deepening inequalities in access to services.
Universal healthcare is provided free of charge through primary care, while patients pay for some hospital services, specialist appointments and medicines. The Commission considers the coverage, availability and geographical distribution of services inadequate, particularly specialist services. Staff shortages are another challenge: the number of nurses per 100,000 residents remains below the European average.
Healthcare workers continue to leave the public sector for the private sector or to work abroad.
The report also notes that recorded cancer cases and the mortality rate from malignant diseases continued to rise last year. Screening campaigns for the early detection of colorectal and breast cancer are conducted in the country, but HPV testing has not yet been included in cervical cancer screening.
The Commission calls for broader public awareness efforts and for more people from target groups to take part in preventive screenings. According to the report, the limited budget and shortage of medical staff also have a negative impact on mental health policies for children and adolescents.
Meanwhile, the country continues its annual programmes to prevent cardiovascular disease. These include early identification of risk factors, preventive check-ups in primary care, health education, and improvements in diagnosis and treatment.
According to the Commission, enforcement of anti-tobacco measures remains inadequate. North Macedonia needs to adopt a new law to bring its rules on tobacco products further into line with European rules, although enforcing it is expected to be a serious challenge. Smoking continues to be tolerated without penalties indoors, including in public institutions, some healthcare facilities and restaurants.
The report also raises concerns about the widespread use of antibiotics, which contributes to antimicrobial resistance—the ability of microorganisms to resist medicines used against them. The national action plan on antimicrobial resistance for 2026–2028 has not yet been adopted.
On infectious diseases, the Commission calls for national legislation to be aligned with European regulations. Since 2016, the country has submitted data to the European TESSy system on several of these diseases, including influenza, HIV/AIDS, hepatitis A, gonorrhoea, West Nile fever and COVID-19. The country also has a system for the early detection of epidemics.
Access to healthcare is particularly limited for women from rural areas and marginalised communities. The report notes that women continue to report cases in which their gynaecologists illegally demand payment for services that should be free under health insurance.
Preventive screening programmes for cervical and breast cancer are available, but are not used equally by all population groups. Initiatives to reduce health inequalities, especially for Roma people, people living in poverty and residents of remote areas, continue with donor support but have limited impact.
In the area of digitalisation, the national e-health system collects data only from public institutions. Because information from private institutions is missing, patients’ health records remain incomplete. The electronic health application is operational, but the appointment scheduling system needs further improvements.
The Commission finds no progress in the area of blood, cells, tissues and organs. National legislation has not yet been aligned with European rules on patients’ rights in cross-border treatment. No new achievements have been recorded concerning medicines for human and veterinary use, health technology assessment, cosmetic products or medical devices.
The document also notes that the country has not yet adopted a consumer protection strategy or created a suitable online platform to inform consumers. To prevent corruption in healthcare, the Commission calls for further efforts in expenditure planning, greater transparency in public procurement, stronger integrity, asset declarations and digitalisation.
