North Macedonia health insurance fund faces €137 m debt and IT flaws as former director becomes health minister

Health Insurance Fund audit debt IT system ministerial appointment

The State Audit Office (DZR) issued a critical report on North Macedonia's Health Insurance Fund, highlighting severe financial shortfalls and systemic IT weaknesses. Unpaid contributions from the pension and disability fund reached about 8.4 billion denars (≈ €137 million) by February 2026, while the Ministry of Health still owed roughly 2.1 billion denars (≈ €35 million) for uninsured persons at the end of 2024.

The audit identified major deficiencies in the Fund’s information system, including incomplete integration with the “My Appointment” platform, delays in implementing electronic prescriptions, and insufficient controls over prescription issuance and billing. In 2024, 44 controls were carried out in hospitals, uncovering irregularities in almost half of them.

Amid these findings, former Fund director Sasho Klekovski, whose tenure coincided with many of the reported issues, was appointed Minister of Health by the ruling DPMNE. Simultaneously, Zlato Perinski was named the new director of the Health Insurance Fund. The Fund is also involved in a lawsuit filed by a German hospital seeking over €430,000 for treatment of Macedonian patients due to unmet financial obligations.

Entities: Health Insurance Fund (Macedonia) · Health Insurance Fund of North Macedonia · Ministry of Health (Macedonia) · Ministry of Health (North Macedonia) · Moj Termin platform · Pension and Disability Insurance Fund · Sasho Klekovski · State Audit Office (DZR) · State Audit Office of Macedonia · Zlato Perinski

Claims

What the coverage asserts, and how well corroborated each claim is across sources.

[● 4 SOURCES] Unpaid contributions to the Health Insurance Fund total about 8.4 billion denars (≈ €137 million) as of February 2026. (State Audit Office report)
[● 3 SOURCES] The Ministry of Health owes roughly 2.1 billion denars (≈ €35 million) for contributions for uninsured persons at the end of 2024. (State Audit Office report)
[● 4 SOURCES] In 2024, 44 controls were performed in hospital institutions, with irregularities found in almost half of them. (State Audit Office report)
[● 4 SOURCES] Former Health Insurance Fund director Sasho Klekovski was appointed Minister of Health by the DPMNE despite audit findings. (Media reports)
[● 4 SOURCES] Controls over issuance and billing of prescriptions are insufficient. (State Audit Office report)
[● 4 SOURCES] A German hospital is suing the Fund for over €430,000 for treatment of Macedonian patients due to unpaid financial obligations. (Media reports)
[● 4 SOURCES] The Fund’s IT system has serious weaknesses, including incomplete integration with the “My Appointment” platform and delays in implementing electronic prescriptions. (State Audit Office report)
[● 4 SOURCES] Zlato Perinski was appointed as the new director of the Health Insurance Fund. (Media reports)