| Verified against primary record | |
| Health spending (2021) | 8.5 per cent of GDP, up from 7.3 per cent in 2019; USD 1,535 per person at purchasing power parity[1] |
|---|---|
| Out-of-pocket share (2021) | 41.7 per cent of health spending[1] |
| Public spending (2021) | 54.5 per cent of health spending, USD 836 per person at purchasing power parity, 4.6 per cent of GDP[1] |
| Hospital beds (2020) | 422 per 100,000 population[1] |
| Physicians and nurses (2020) | 296 per 100,000 against an EU average of 412, and 440 nurses per 100,000 against an EU average of 838[1] |
| Catastrophic health spending (2018) | About 7 per cent of households[1] |
| Unmet need for a medical examination due to cost (2020) | 1.1 per cent overall, down from 10.1 per cent in 2010; 3.1 per cent in the lowest income quintile against 0.2 per cent in the highest[1] |
| Medical tourism in the profile | Not mentioned; the only movement abroad recorded is about 300 nurses leaving to work abroad in 2018[1] |
| Bands apply only to the rows beneath them. No count of foreign patients treated in North Macedonia, no revenue figure and no count of residents treated abroad was located, and none has been estimated. The insurance coverage figure is from a survey of respondents rather than an administrative count. No typical cost range is given because no official source publishes prices paid by foreign patients. | |
Medical tourism in North Macedonia does not appear in the country’s comparative health system assessment. What that assessment records instead is a system where patients pay 41.7 per cent of health costs directly, physician and nurse densities well below European Union averages, and a workforce leaving: about 300 nurses went abroad to work in 2018.
What the profile records
The Health Systems in Action insight for North Macedonia, 2024 edition, by Bernd Rechel, Simona Atanasova and Neda Milevska-Kostova, published by the WHO Regional Office for Europe with the European Observatory on Health Systems and Policies, records health spending at 8.5 per cent of gross domestic product in 2021, up from 7.3 per cent in 2019 though below 8.9 per cent in 2000, and 1,535 United States dollars per person at purchasing power parity. Public spending was 54.5 per cent of health spending, 836 dollars per person and 4.6 per cent of gross domestic product, leaving out-of-pocket payments at 41.7 per cent.[1]
Hospital beds stood at 422 per 100,000 population in 2020. Physicians numbered 296 per 100,000 against a European Union average of 412, and nurses 440 per 100,000 against a European Union average of 838. In a November 2022 survey, 96.0 per cent of respondents reported having health insurance from the Health Insurance Fund. About 7 per cent of households faced catastrophic health spending in 2018. Unmet need for a medical examination because of cost was 1.1 per cent of the population in 2020, down sharply from 10.1 per cent in 2010, though it stood at 3.1 per cent in the lowest income quintile against 0.2 per cent in the highest.[1]
Two of those figures sit oddly together and the tension is worth naming. Unmet need due to cost fell to 1.1 per cent, which is a low figure by European standards, while out-of-pocket payments remained at 41.7 per cent of all health spending. A population paying over two fifths of health costs directly while almost none reports forgoing an examination because of cost suggests that people are paying rather than going without, which is a different kind of problem from unmet need and one that the catastrophic spending figure of 7 per cent of households captures better.
The nurse density of 440 per 100,000 against a European Union average of 838 is the starkest single comparison in the profile. Roughly half the European nursing provision, in a country that lost about 300 nurses to work abroad in 2018, is the context for any proposal to serve foreign patients.[1]
The silence, and what it means
The profile does not mention medical tourism, health tourism, foreign or international patients, or citizens receiving treatment abroad. The only passage concerning people going abroad is about health workers leaving.[1]
North Macedonia’s profile belongs to the Health Systems in Action insight series, produced by WHO Europe with the European Observatory for countries in the WHO European Region outside the European Union, launched on 28 January 2025 and built on a common template to ensure consistency and support cross-country comparison, updated every two years. The launch page originally described the series as covering 17 countries, and a correction reduced that to 15 by removing Andorra and Azerbaijan.[2]
Because the template is shared, the absence of inbound patient care from the North Macedonian profile is not a local editorial decision. The same silence appears in the profiles for Armenia, Georgia, Kazakhstan, Uzbekistan and Israel, which establishes that medical travel is simply not among the dimensions these assessments measure. That makes the silence evidence about the framework and not about the country.[2]
Israel makes the point sharply. Its profile in the same series is equally silent on medical tourism, and Israel regulates the activity by dedicated primary legislation. A country can have a substantial and heavily governed medical travel sector and still have none of it appear in this kind of comparative assessment.
What is not recorded
No North Macedonian count of foreign patients, revenue figure, outbound patient figure or accreditation register was located for this article. The country is promoted commercially for dental treatment, cosmetic surgery and fertility services, serving patients from elsewhere in the Balkans, from western Europe and from the Macedonian diaspora. No official figure quantifying any of that was found, and none has been estimated.
The Centers for Disease Control and Prevention records dental care as the most common form of medical tourism among United States residents, lists cosmetic surgery, dental care, cancer treatment, fertility treatment and organ transplantation as the procedures most often sought abroad, and states that accreditation does not guarantee a good outcome.[3]
Limits of the evidence
Every figure here describes the North Macedonian health system rather than medical travel to or from it, because no source quantifying patient movement was located. The insurance coverage figure comes from a November 2022 survey of respondents and is not an administrative count. Spending, bed, workforce and unmet need figures span 2018 to 2022 and are reported with the years the profile gives rather than harmonised. Commercial promotion of the country as a destination is described as promotion and is not quantified.
See also
- Medical tourism in Serbia, a neighbour assessed on the same template
- Medical tourism in Albania, the regional dental destination with figures from its source market
- Medical tourism and health workforce migration, the only movement the profile records
- Medical travel and treatment affordability, where patients pay 41.7 per cent directly
- Medical tourism in Israel, equally silent in the same series despite legislating on the subject
References
- Rechel, B., Atanasova, S. and Milevska-Kostova, N. Health Systems in Action Insights: North Macedonia, 2024 Edition. WHO Regional Office for Europe and European Observatory on Health Systems and Policies, Copenhagen, ISBN 978 92 890 5976 3. Verified against primary record: the document was opened and health spending of 8.5 per cent of GDP in 2021 against 7.3 per cent in 2019 and 8.9 per cent in 2000, per capita health spending of USD 1,535 at purchasing power parity in 2021, the out-of-pocket share of 41.7 per cent of health spending in 2021, public spending of 54.5 per cent of health spending at USD 836 per capita and 4.6 per cent of GDP, hospital beds at 422 per 100,000 population in 2020, physicians at 296 per 100,000 in 2020 against an EU average of 412, nurses at 440 per 100,000 in 2020 against an EU average of 838, the November 2022 survey finding that 96.0 per cent of respondents reported having Health Insurance Fund insurance, catastrophic health spending affecting about 7 per cent of households in 2018, unmet need for a medical examination due to cost at 1.1 per cent of the population in 2020 against 10.1 per cent in 2010 with 3.1 per cent in the lowest income quintile and 0.2 per cent in the highest, the statement that about 300 nurses left North Macedonia to work abroad in 2018, and the complete absence of any reference to medical tourism, health tourism, foreign or international patients or citizens receiving treatment abroad were read directly. Copyright and suggested citation are dated 2025 and the numbered pages run to 26. Retrieved 23 October 2026.
- WHO Regional Office for Europe. WHO Europe and European Observatory launch Health Systems in Action insights for non-EU countries. 28 January 2025. Verified against primary record: the page was opened and the identity and producers of the series, its coverage of countries in the WHO European Region outside the European Union including North Macedonia, Armenia, Georgia, Kazakhstan, Uzbekistan, Israel and Serbia, the fact that the page originally described the series as covering 17 countries with a correction reducing this to 15 by removing Andorra and Azerbaijan, the stated purpose of providing a concise health system overview and a baseline for tracking change, the use of a common template to ensure consistency and support cross-country comparison, the two-yearly update cycle, and the sources the series draws on were read directly. Retrieved 23 October 2026.
- Stoney, R. J. and Leidel, L. Medical Tourism. CDC Yellow Book: Health Information for International Travel, 2026 edition, United States Centers for Disease Control and Prevention. Page dated 23 April 2025. Independently reported: the chapter was opened and the statement that dental care is the most common form of medical tourism among United States residents, the listing of cosmetic surgery, dental care, cancer treatment, fertility treatment and organ transplantation as the procedures most often sought abroad, and the statement that accreditation does not guarantee a good outcome were read directly. Retrieved 23 October 2026.
Sourcing note: the profile’s silence on medical tourism is explained by the series template rather than treated as a finding about North Macedonia, and Israel is cited as the case proving the point, since it is equally silent in the same series while regulating the activity by statute. The apparent tension between a 41.7 per cent out-of-pocket share and 1.1 per cent unmet need is named rather than smoothed over. Commercial promotion of the country is described as promotion and left unquantified.