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.

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During its review of municipalities’ work in 2025, the State Audit Office found that local authorities do not collect taxes in accordance with legal requirements and fail to efficiently manage the taxes and financial liabilities of entities.

The State Audit Office report states that the policies and measures undertaken by local self-government units, together with the responsible authorities, do not ensure the efficient administration of local taxes, fees and charges.

The audit found that, over a five-year period, municipalities failed to collect at least €50 million. Some of these liabilities are now time-barred, meaning the tax can no longer be collected.

The auditors also noted that most municipalities, particularly rural ones, have not updated the prices used to calculate taxes. As a result, the tax base has been set below its actual value.

According to the report, prices that have remained unchanged for years and do not reflect current market values continue to be used. This leads to an undervalued tax base and lower revenues for municipalities.

An analysis of revenue generated from taxes, fees and charges showed that rural municipalities generally have weaker fiscal capacity than urban municipalities. Petrovec, Ilinden and Čučer-Sandevo are exceptions to this finding.

Tax receivables worth more than 856 million denars have accumulated in 14 municipalities. Kumanovo, Veles, Kočani, Kratovo, Aračinovo, Studeničani and Kriva Palanka were classified as municipalities with low fiscal capacity.

Tetovo, Saraj and Gazi Baba demonstrated medium fiscal capacity, while Čair, Aerodrom, Karpoš and the City of Skopje were identified by the auditors as units with advanced fiscal capacity.

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