# Balkan health funds face delays, debt, spending crackdown > Live situation record from CLSTR: https://clstr.news/situations/health-insurance-fund-delays-in-the-balkans > Updated: 2026-08-05T15:15:43.000Z. Sources: 20. Developments: 6. In July 2026 Albania’s Health Insurance Fund was found to have left dozens of applications and voucher cases unresolved since 2019, with several patients still awaiting approval for treatment abroad. A National Auditing Office report on 12 July added that 15 citizens remain pending for foreign treatment and that decisions from 2019‑2025 total dozens, alongside 24 voucher cases worth over €738,000 issued without the required pro‑invoices. The audit also noted under‑valuation of the asset register and over‑valuation of contingent liabilities, with the board accepting only two of four recommendations. North Macedonia’s Health Insurance Fund continued to struggle with liquidity, with arrears of about 8.4 billion denars from the pension and disability scheme and roughly 2.1 billion denars from the Ministry of Health. Auditors highlighted irregularities in nearly half of inspected hospitals, weak procurement planning and an outdated, only partially integrated IT system. On 28 July the fund announced a record payout of 560.9 million denars for medical‑leave benefits. The opposition Levica party warned on 22 July that many mothers still had not received May maternity payments, describing the delays as a regular practice and demanding immediate, guaranteed disbursements and fixed deadlines. On 5 August Fund director Zlatko Perinski announced a crackdown on the fund’s biggest financial leak – overseas treatment spending estimated at about 500 million denars (over €8 million) a year. He also reported a 33 % rise in long‑term disease benefits since the COVID‑19 pandemic, with more than 300,000 registrations in 2025, and the creation of a working group, supported by the Ministry of Health, medical chambers and the WHO, to audit approvals, tighten controls and simplify the disease‑benefit system. Leadership changes saw former director Sasho Klekovski become Minister of Health while Zlato Perinski took over as Fund director. ## Claims - The Health Insurance Fund paid a total of 560.9 million denars in July for medical leave compensations. (corroborated by 5 sources) - 420.3 million denars were allocated for maternity‑leave compensation. (corroborated by 5 sources) - 140.6 million denars were allocated for other types of medical leave. (corroborated by 5 sources) - The July payouts represent the highest amount ever paid in a single month for maternity‑leave compensation. (corroborated by 5 sources) - Between 1 – 23 July, 111 million denars were paid for maternity leave and 93.5 million for other leave. (corroborated by 5 sources) - On 24 July, 25 million denars were paid for maternity leave and 24 million for other leave. (corroborated by 5 sources) - On 27 July, 198 million denars were paid for maternity leave and 17.7 million for other leave. (corroborated by 5 sources) - On 28 July, 86.3 million denars were paid for maternity leave and 5.4 million for other leave. (corroborated by 5 sources) - Unpaid contributions to the Health Insurance Fund total about 8.4 billion denars (≈ €137 million) as of February 2026. (corroborated by 4 sources) - The Fund’s IT system has serious weaknesses, including incomplete integration with the “My Appointment” platform and delays in implementing electronic prescriptions. (corroborated by 4 sources) - Controls over issuance and billing of prescriptions are insufficient. (corroborated by 4 sources) - In 2024, 44 controls were performed in hospital institutions, with irregularities found in almost half of them. (corroborated by 4 sources) ## Timeline ### 2026-08-05: Macedonia's Health Insurance Fund Director Zlatko Perinski Announces Crackdown on Overseas Treatment Spending Macedonia's Health Insurance Fund director Zlatko Perinski announced new controls targeting the roughly 500 million denar outflow on overseas treatments, rising long‑term disease benefits and costly orthopedic 3 sources. https://clstr.news/cluster/macedonias-health-insurance-fund-director-zlatko-perinski-announces-crackdown-on-overseas-treatment- ### 2026-07-31: Macedonia's Levica Party warns of ongoing chaos in maternity benefit payments Levica's Evgenija Stankoska said Macedonia's health insurance fund still fails to pay maternity benefits, urging immediate full payouts, fixed deadlines and accountability from director Zlatko Perinski and the‑ 2 sources. https://clstr.news/cluster/macedonias-levica-party-warns-of-ongoing-chaos-in-maternity-benefit-payments ### 2026-07-30: North Macedonia health insurance fund faces €137 m debt and IT flaws as former director becomes health minister North Macedonia's Health Insurance Fund was flagged for €137 m unpaid contributions, IT system flaws and weak controls; former director Sasho Klekovski was appointed health minister while Zlato Perinski became 8 sources. https://clstr.news/cluster/macedonias-health-insurance-fund-faces-huge-debts-and-it-flaws-audit-finds ### 2026-07-28: Macedonia Health Fund pays record 560.9 million denars for medical leave Macedonia’s Health Insurance Fund paid a record 560.9 million denars in July for medical leave, including 420.3 million for maternity leave, marking the highest monthly payout for such benefits. 7 sources. https://clstr.news/cluster/macedonian-health-insurance-fund-disburses-record-5609-million-denars-for-sickness-benefits ### 2026-07-22: Macedonia Health Insurance Fund criticized over delayed maternity benefits Levica alleges Macedonia's Health Insurance Fund still delays maternity payouts despite a new director, leaving many mothers unpaid for May and calling for urgent action. 4 sources. https://clstr.news/cluster/macedonias-health-insurance-fund-faces-ongoing-maternity-benefit-delays ### 2026-07-12: Albanian Health Insurance Fund faces audit‑revealed delays for 15 patients Albania's Health Insurance Fund has left 15 applications for overseas treatment pending, with dozens of unexecuted decisions since 2019 and €738k in improperly issued vouchers, according to a ZKA audit. 3 sources. https://clstr.news/cluster/albanian-health-insurance-fund-faces-auditrevealed-delays-for-15-patients --- Cite as: Balkan health funds face delays, debt, spending crackdown. CLSTR, https://clstr.news/situations/health-insurance-fund-delays-in-the-balkans