SAO: HIF Liquidity Affected by Early Payment of Funds Based on Contributions from Competent Institutions

The State Audit Office audited the financial statements and the compliance of the operations of the Health Insurance Fund of the Republic of North Macedonia for 2024. The auditors issued a qualified opinion on the fair and accurate presentation of the financial statements, as well as on the compliance of operations with the relevant legal provisions. Although measures have been taken to implement recommendations from previous audits, weaknesses remain and require systemic improvements.

According to the audit findings, the Fund’s liquidity is affected by the early payment of funds derived from contributions by the competent institutions. As a result, it is more difficult to settle obligations to healthcare institutions on time, within the agreed reimbursement limits.

Specifically, as of February 2026, the Pension and Disability Insurance Fund’s unpaid contribution obligations amounted to 8,415,865 thousand denars, or approximately 137 million euros. Meanwhile, the gap between planned funds and their actual realization continues to widen.

Due to insufficient budget funds, at the end of 2024 the Ministry of Health had 2,136,300 thousand denars in unpaid funds, approximately 35 million euros, for contributions for uninsured persons.

Problems were also identified in the operation and development of the Fund’s information system. The audit found a lack of strategic documents, insufficient human resources, only partial operation of several modules, and limited scope for their further development. The establishment of the electronic prescription system has also been delayed, while the system’s current controls during the issuance and billing of prescriptions do not guarantee an adequate level of oversight.