Joint reaction of a group of civil society organizations:
We request the Country to establish a regulatory framework for determining the treatment related to COVID-19 that citizens cover with personal funds in private health institutions, following the example of the determined maximum amount for payment of participation with personal funds (participation) in public health in accordance with the Price List of health services of the Health Insurance Fund.
We suggest that the Health Insurance Fund conclude an agreement with all accredited laboratories for the PCR test health service to determine the presence of the SARS-CoV-2 virus or enable the costs to be covered or reimbursed.
We expect the Health Insurance Fund to enter into contracts with all laboratories for health services closely related to the monitoring and assessment of the health status of patients with COVID-19, according to established practice and evidence-based medicine.
Pending that the state and the Fund ensure that laboratory health services related to diagnostics and monitoring of patients with COVID-19 are financially covered by the state.
For the following reasons:
The sharp increase in new cases of COVID-19, together with the insufficient number of recoveries to free up beds for new patients who need to be hospitalized, inevitably raises the question of the universal right of access to health care. At the same time, in conditions where 85,000 Macedonian citizens live on 40 denars a day and almost every fourth person survives on no more than 126 denars a day, private health services of thousands of euros cannot be considered as enabled access to use this human right.
The Constitution of the Republic of North Macedonia guarantees every citizen the right to health care. This implies timely and appropriate access for Macedonian citizens to health care at an affordable price and quality. Access to adequate health care cannot depend on the social status, that is, the property position of the citizens, which is clearly determined by the decisions of the Constitutional Court. As a matter of fact, the triage itself never sets these circumstances as a criterion for determining the priority in terms of access to health care.
According to the International Covenant on Economic, Social and Cultural Rights, the state bears the obligation to protect the right to health. Part of this obligation of the state is the obligation to ensure that the provision of health services by private entities “will not be a threat to the availability, accessibility, acceptability and quality of health facilities, services and services”. The Committee on Economic, Social and Cultural Rights is determined that:
“health facilities, goods and services must be affordable for everyone. Payment for health services, as well as for services related to the basic determinants of health, must be based on the principle of equity, ensuring that such services, whether public or private, can be afforded by all, including socially disadvantaged groups. Such equity requires that poorer households are not disproportionately burdened with health care costs compared to wealthier households.”
Health care is an activity of public interest, regardless of whether it is performed in public or private health institutions. The government and the Ministry of Health are obliged to ensure the realization of the public interest even in the crisis situation in which we are at the moment.
The pandemic has caused public health facilities to be overcrowded with patients and unable to provide health care to all citizens suffering from COVID-19 who need hospital treatment, and treatment in private hospitals with their prices set too high is a privilege for the few. In addition to concluding an agreement with private hospitals through FZO, the state needs to set a limit for the maximum amount of one private treatment for COVID-19.The regulation of prices and the determination of criteria for the allocation of hospital beds is absolutely necessary so that we do not end up in a situation where there is a place in private health facilities, and there is no possibility of treatment through the Fund, which would make these places unavailable for a huge majority of Macedonian citizens. Otherwise, private interest will prevail over public interest.
The possibility of treating patients positive for COVID-19 at the private hospitals in the network of health facilities and concluding an agreement with the FZO was foreseen by the Decree with legal force on the application of the Law on health care during a state of emergency adopted by the Government which is now out of legal turnover, however no such agreement was concluded.
However, with the recent amendments and additions to the Law on the Protection of the Population from Infectious Diseases, private hospitals retained the right to treat patients with COVID-19, but without leaving the possibility of providing these services in the network of health facilities and concluding a contract with the FZO. Thus, this law, in addition to treatment in public health institutions, provides that according to medical indications, the sick can be treated and isolated in private health institutions that have a license to perform the activity of intensive care and therapy. In order to treat patients from COVID-19, private healthcare facilities need to have the consent of the Ministry of Health, i.e. a license to perform intensive care and therapy activities. In the case of fulfillment of the capacities for treating patients with COVID-19 in public health institutions, after the prior consent of the Ministry of Health, the treatment of persons can also be carried out in private health institutions that have a license to perform the activity of intensive care and therapy. What this law left as a gap is the non-regulation of the financial implications of health services by private health institutions. However, even in such a situation, Article 60 of this Law stipulates that for the implementation of special measures, funds are provided by:
- The health insurance fund for persons who are compulsorily insured;
- The budget of the Republic for the implementation of preventive programs for persons who are not covered by mandatory health insurance and
- Employers for mandatory health and hygiene examinations of employees.
The assessment of these implications is the obligation of the state, together with the provision of economic availability of services for all , including those services provided on the basis of this Decree. Any action contrary to this means a violation of the state’s obligations regarding the right to health of its citizens. Due to the situation in which the country finds itself as a result of the pandemic, the Government and the Ministry of Health have a legal obligation to take measures that, on the one hand, will ensure equal access to health care, and on the other, will use the capacities of public and private health care.
Due to all this, we call on the Government of the Republic of North Macedonia as soon as possible to take measures regarding the appropriate regulation of the work of private hospitals in crisis conditions in a way that will give consent to care for patients from COVID-19 only to those private hospitals who have concluded an agreement with FZO, as well as to take the initiative for proper regulation of prices for health services in private health institutions and to put an end to profiteering during a life-threatening crisis. Let’s not allow a systematic violation of the right to access to health care, so that the chances of survival will depend on who has more friends and money to be able to save their lives and the lives of their loved ones.
This request is supported by:
– Helsinki Committee for Human Rights
– Open Society Foundation – Macedonia
– Macedonian Association of Young Lawyers
– Institute for Human Rights
– Coalition “All for a fair trial”
– Center for legal research and analysis
– Association for Emancipation, Solidarity and Equality of Women ESE
– HOPS – Options for a healthy life
– MARGINI coalition
– Station P.E.T.
– Institute for European Politics
– Transparency International – Macedonia
– FORUM Association – Center for Strategic Research and Documentation
– Association for education and counseling “Dr. Berat” – Skopje
– Eurotink – Center for European Strategies
– Organization of women from Strumica
– Association for the development and promotion of the Roma community – ROMANO CHACHIPE
– Foundation for debate and education IDEA Southeast Europe
– Association Center for Investigative Journalism SKUP-Macedonia
– Foundation for the development of the local community-Shtip
– Association for Democratic Development of Roma “Sun” – Tetovo
– Association for Democratic Initiative “ADI” – Gostivar
– NGO “KHAM” Delchevo
– Writers’ association “Tikveshki tsvevi” – Kavadarci
– Association for educational development “EKVALIS” – Skopje
– Center for the promotion of sustainable agricultural practices and rural development
– Dyslexia Association “EINSTEIN”
– Center for research and policy making “CIKP” – Skopje
– “Templum” publishing house
– “Okno” portal
– Association of citizens for health, social and educational support “Initiative for Development and Inclusion of Communities” – Skopje
– Theater “ROMA” – Skopje
– Association “Decent Worker” – Prilep
– CORE – Association of the independent cultural scene
– Metamorphosis Foundation
– National Roma Center – Kumanovo
– National Youth Council of Macedonia
– Association for support of marginalized workers “STAR-STAR” – Skopje
– Association of Roma Business Information Center in Macedonia
– Multiculture Association – Tetovo
– Association of agricultural producers “Agroproduct” – Shtip
– CEED Foundation – Macedonia
– Geosphere – Bitola
– Connect
– Stronger together – Skopje
– Macedonian Center for International Cooperation MCMS – Skopje
– Institute for Democracy “Societas Civilis” – Skopje
– Ohrid Institute
– The Foundation for Educational and Cultural Initiatives “Step by Step”