This , so called communist system was based on the following points :
- Full quantity of benefits for every citizen in Macedonia , starting from primary to terciery health care
- Free drug supply
- Total government based menagement in Macedonia`s health insurance system , with only one major Health Insurance Fund ( HIF )

Looking from the surface , from benefitiants point of view , this system was almost perfect , but from economic point of view it was totally negativ for the country . National HIF month by month , was going into bigger and bigger depts . In November 1998 , leak in HIF account was around 60 million US Dollars , wich for such a small country as Macedonia is – it was too much .

Public incomes in the 1991-1998 period were down to 40 % due to unappropriate benefitions in the relationship with :

1. General finansial situation of the country

- decreasing of monthly salaries
- lack of payment of monthly salaries in the period of several months or payment out of any legal finansial transaction – paying with company goods with ilegal cheques , or in cash from company`s daily income .
– decreasing the number of employees in former government ruled companies
- going in to a bankrupt , common thing for state companies
- conscious tax evasion for health insurance
- unefficient government in collecting public taxes and incomes especialy towards private companies

2. Mistakes made in finansial politics in national helath insurance system

- Unexistance of proper finansial system for health services made by the national Health Insurance Fund ( HIF )
– Lack of public monitoring during the process of purchasing of materials used in public health sector .
– Until 1998 there was no "Law for Public Supplies "
- Illegal increase the cost for materials used in public health sector by creating add pages of already signed conctracts .
– HIF extended health insurance system by covering health expences at some (not all of them) private health organizations , without previous plan or analysys .
– Lack of finances for Public Health Organizations for :
- purchasing new medical equipment
- drugs
- improving working conditions

3. Mistakes made in benefiary packages

- overnumbered benefits covered by HIF at all three grades of health service
– overnumbered group of insureds ( 26 groups )

From 2,2 million citizens in the Republic of Macedonia , until the December 1999 , covered by national health insurance were :

- Luxury health services were covered by insurance
- Treating insured patients in secondary health care instead in primary where they belong
- Covering health services that Macedonian insureds made abroad , while there were a possibility to accomplish in domestic health system .

4. Mistakes made in employees policy in public health sector

- No concern for numer of employees ( overnumbered )
- No concern for employee`s payment ( too small )

One average montlhy salary in public sector in Macedonia = 180 US dollars

- Wrong student policy – more medical , dental and pharmaceutical students than the needs in public health sector

5. Pharmacy

- Unexistence of upper limit in drug prices covered by insurance
- Lack of control in issuing drug prescriptions covered by insurance
- Illegal finansial activities in Major Pharamaceutical companies ( selling drugs who should be covered by insurance , creating artifitial lack of drugs in the market , etc. )

This were 5 major reasons for finansial nock-down that happened to Macedonian health insurance system . This situation comprise the period from 1991 until 1999 . In 1999 , Macedonian government with WBI help started with reforms in public health sector .

We all look forward for better days .