North Macedonia’s Health Minister Azir Aliu on Friday unveiled a draft law on medicines aimed at modernising the system, speeding up drug approvals and improving patient safety, while authorities simultaneously intensify scrutiny over suspected abuses in the public healthcare sector.
Aliu said the draft legislation forms part of broader health sector reforms designed to align the country with European standards, improve access to treatment and ensure more sustainable management of the system.
“The new law aims to modernise the medicines system and increase patient safety,” Aliu told a press conference, adding that it would introduce faster procedures for drug approval and registration, shortening the time needed for medicines to reach patients.
The proposal includes a system to monitor drug supply chains to prevent shortages, as well as electronic tools for tracking and analysing consumption. It also предусматриes stronger quality and safety controls, improved pharmacovigilance and enhanced coordination between institutions.
New, stricter rules for clinical trials and a system for managing pharmaceutical waste from households are also planned.
Aliu said the draft would be published on the national electronic registry (ENER) on Monday, allowing public feedback.
Concerns over disparities and potential abuse
The announcement comes amid a wider debate on the functioning of the public healthcare system after Prime Minister Hristijan Mickoski and the health minister revealed large disparities in doctors’ workloads and high payments linked to on-call duties.
Aliu said one doctor in the public system had received monthly pay of 700,000 denars (about $12,000), without disclosing details, adding that institutions were already handling the case and that criminal liability could not be ruled out if wrongdoing is confirmed.
Ministry analyses, he said, show stark differences in workload, with some doctors treating only one patient per week, while others handle up to 100.
“Both extremes are deviations and are not acceptable,” Aliu said.
He cited an example of two specialists in the same field, one performing 1,134 surgeries compared to 470 by another, while in some regions doctors carried out no surgeries at all in 2025.
Large discrepancies were also found in referral numbers, with one doctor issuing more than 16,500 referrals over six months, compared with just over 7,300 by another.
In seven clinics, additional work exceeded the legal limit of 20%, reaching as high as 41%, he added.
Digital controls and tighter oversight
To strengthen oversight, the ministry is testing fingerprint-based attendance systems in two clinics in Skopje, with plans to expand nationwide.
Aliu said the goal is to ensure that every step in the healthcare process is recorded and visible to oversight mechanisms, stressing that digitalisation must go beyond simply introducing computers.
“Patients cannot wait months for operations while capacities remain underutilised during working hours,” he said.
The government also plans to connect pharmacy software to a central system to prevent manipulation of prescriptions and drug stocks.
Authorities will seek data from private healthcare providers to assess how much time public-sector doctors spend working outside the system.
Previous audits flagged irregularities
Concerns over abuse of on-call payments were raised in late 2025, when Sasho Klekovski said inspections in 26 public health institutions found irregularities in 18 of them.
Findings included miscalculations of on-call and overtime work, double payments and breaches of legal limits on overtime hours. Eight institutions failed to submit required documentation.
Prime Minister Mickoski told parliament earlier that some healthcare workers were earning more than 10,000 euros per month through on-call payments, including cases where individuals reported working 24 hours a day for 31 consecutive days.
In this context, the proposed medicines law is seen as part of a broader effort to improve transparency, control and efficiency in the healthcare system, amid ongoing complaints from patients about long waiting lists and limited access to services.
Aliu said the intention is not to “create a spectacle,” but to prevent abuse and build a system that functions effectively in real time.
“The goal is to create a system that truly serves citizens without such deviations,” he said.