This article gives an insight to the current health insurance system in the Republic of Macedonia. Special
emphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to the
scope of the insured persons and their benefits and obligations, the way of calculating and payment of the
contributions and the other sources of revenues for health insurance, user participation in health care
expenses, payment to the health care providers and some other aspects of realization of health insurance in
practice. According to the Health Insurance Law, which was adopted in March 2000, a person can become an
insured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to the
obligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008
payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wages
and almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activities
of the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financing
and reform of the payment to health care providers are of high importance within the ongoing health care
reform in Macedonia. It is expected that the newly introduced methods of payments at the primary health care
level (capitation) and at the hospital sector (global budgeting, DRGs) will lead to increased equity, efficiency
and quality of health care in hospitals and overall system.