The Healthcare System in North Macedonia: How a French National Accesses Care

According to CLEISS, health insurance is managed by the Health Insurance Fund of the Republic of North Macedonia (FZO), which applies health legislation under the authority of the Ministry of Health, with local branches. Hospital care is provided in public hospitals or contracted private establishments. A State programme covers people with no other protection, such as children under 18 (27 if studying), older people and unemployed women during pregnancy and childbirth. Voluntary supplementary insurance is offered.

France Diplomatie describes adequate facilities in the large cities, but potentially limited ones in rural areas. For an expat, the frequent combination pairs the affiliation linked to employment, where it exists, with a private or international contract that opens access to private practitioners, medical evacuation and repatriation. See expat health insurance to compare the options.

CLEISS states that those insured are employees, self-employed workers, retirees, people registered with the employment agency and social assistance recipients; spouses and dependent children are covered as dependants. No waiting period applies to care in kind, which opens from the first day of insurance. Contributions are exclusively employer-paid: 7.3% of gross salary for sickness-maternity, with no direct employee share; the self-employed person also contributes 7.3% for sickness-maternity. The CLEISS page contains no rule specific to foreigners: the affiliation of a French employee recruited locally goes through their employer, and that of a non-working resident should be confirmed with the Fund.

For a posted worker or a retiree of French social security, the Franco-Yugoslav agreement of 1950, applicable since the exchange of letters of 14 December 1995, organises cover on the basis of French forms: see healthcare reimbursement in North Macedonia.

You must be registered with a general practitioner: specialists can only be consulted on referral. The patient does not advance costs and pays their contribution of 10% to 20% of the cost depending on the type of care, except in an emergency. When the annual contribution exceeds 70% of the previous year’s average monthly net salary, the Fund may exempt the patient from the remaining costs for the year. Retirees whose pension is below the national average are fully exempt (CLEISS).

Hospitalisation takes place in public hospitals or contracted private establishments. France Diplomatie names no particular establishment; the French embassy in Skopje (165 Aleksandrov Todor street, +389 2 324 43 00) can advise on practitioners. A medical file translated into English speeds up the handling of ongoing treatment, and the page recalls that facilities in rural areas may be limited.

Only medicines on the Fund’s list are reimbursed, with a patient contribution of 5% to 20%. Dental care covered is limited to periodic check-ups and primary preventive care, with 20% at the patient’s expense; other dental care falls under the private sector or supplementary insurance (CLEISS). France Diplomatie specifies that pharmacy chains generally stock common medicines, and advises taking only what is strictly necessary in the original packaging, with a prescription using the international non-proprietary name, checking that each product is authorised in North Macedonia and never buying medicines from street vendors because of counterfeits.

For sick leave, a certificate from the general practitioner covers the first 15 days, then a Fund commission examines the file. The employer pays the first 30 days at 70% to 85% of the average net salary of the last 12 months depending on the cause, then the Fund takes over at the same rate for 12 months at most; the self-employed person receives nothing for the first 30 days, then 70% of the previous year’s average monthly income (85% for a malignant tumour), up to four times the national average net salary. At least six months of insurance are needed to open these rights.

Maternity leave lasts 9 months (15 months for multiple births), including 28 days of prenatal rest and at least 45 days postnatal, with an allowance of 100% of the salary or of average income over the last 12 months, after six months of contributions. Work accidents, commuting accidents and listed occupational diseases are covered with no qualifying period, with a daily allowance of 100% of average net income from the first day, for 12 months at most.

France Diplomatie describes a dangerous road: unpredictable driving, ageing infrastructure, unlit vehicles, farm machinery, carts and animals. After an accident, you must make the occupants safe without moving the vehicle, call the police, an ambulance if necessary and the insurer, then take photos. There is no public rescue service in the high mountains: hikers stay on marked trails, do not go alone and avoid off-piste skiing. Insurance that covers rescue and evacuation answers this absence of a public service.

The Safety page also recommends reading the French government’s earthquake instructions and the leaflet of the French embassy in Skopje, the whole territory lying in a seismic zone with regular tremors of low to medium intensity. Protection against heat, sun, mosquitoes and animal bites is among the basic prevention measures, as are hand hygiene and choosing safe water.

The France Diplomatie pages consulted list no emergency number; they give the switchboard of the French embassy in Skopje (+389 2 324 43 00) and its consular section (+389 2 551 77 28). Local emergency numbers should be confirmed with the embassy before departure. Emergency care is exempt from co-payment for a Fund insured person (CLEISS). For a person with no cover, France Diplomatie recalls that the embassy cannot pay medical costs and that medical repatriation costs can be very high: taking out cover before travelling is strongly recommended. See the guide repatriation and assistance.

France Diplomatie recommends keeping the usual vaccines up to date (diphtheria, tetanus, polio, whooping cough, measles) and, depending on the conditions of the stay, enquiring about hepatitis A, typhoid, hepatitis B for frequent or prolonged stays and rabies for young children and rural or isolated areas. The risks cited are typhoid, which can be fatal without treatment, rabies, almost always fatal once symptoms appear (consult immediately after any risky exposure, even if vaccinated), and West Nile fever, transmitted by mosquitoes and with no human vaccine: prevention relies on protection against bites. The page adds food and water hygiene, caution around animals, road safety, protection against heat and sun and water safety. The whole territory is in a seismic zone. See also living in North Macedonia.