MILS: News from the FYROM, 96-11-29

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From: "Macedonian Information Liaison Service" <[email protected]>

CONTENTS

[01] MAYORS IN 79 MUNICIPALITIES AND SKOPJE TO BE ELECTED IN ROUND 2

[02] ROLE OF UNPREDEP IN MAINTAINING PEACE AND STABILITY EMPHASIZED

[03] DONOR CONFERENCE ON MACEDONIA NEXT FEBRUARY

[04] POLISH-MACEDONIAN TALKS FOCUS ON ECONOMIC COOPERATION

[05] FRENCH MILITARY DELEGATION IN MACEDONIA

[06] DENIAL OF INFORMATION ON GREEK MILITARY AIRCRAFT VIOLATING MACEDONIAN TERRITORY

[07] LANGUAGE COMPROMISE TO INCREASE ECONOMIC COOPERATION

[08] MACEDONIA OFFICIALLY FREE OF HOOF AND MOUTH DISEASE

[09] SKOPJE - THE WORLD STUDENT CENTRE

MILS SUPPLEMENT

[10] `Additional Insurance, Payments or Deductions' (`Nova Makedonija' - 27th November 1996)

MILS NEWS

Skopje, 29th November, 1996

[01] MAYORS IN 79 MUNICIPALITIES AND SKOPJE TO BE ELECTED IN ROUND 2

Based on NEC data released yesterday, on 17th November voting procedures were completed in 30 municipalities - and since then elections have been repeated at Bistrica, Vratnica and Karvinci where the appeal deadline has to expire before outcomes are announced. The same is to occur at Rusjaci, Suvodol, Gorno Hrushje and Makedonski Brod on 1st December. As is the case in six polling stations at Orizari, where municipal counsellors are also to be elected.

In Kratovo mayor elections are to be repeated in all polling stations, and counsellor elections in two of them. Two polling stations at Lipkovo will also repeat round 1. In Krivogashtani this applies to 3 polling stations, in Lozovo: 1, Tetovo: 2, Podaresh: 3, Bogdanci: 7, Sopishte: 1 and Kamenjane: 4.

Throughout round 2 of mayor elections 1 199 696 people will be entitled to vote, and 1 554 377 voting slips have been printed to that purpose. It has already been announced the this second round will not be monitored by international observers, as round 1 had been completed without major or more serious deficiencies regarding election procedures.

During yesterday's press conference, when asked how the 68 appeals on the violations of the right to vote accepted by the Supreme Court would be handled, the NEC president replied that this was to be attributed to the fact that people moved from one election unit to another, which is why Election Commissions should not be that rigorous in implementing the Law on Local Elections, and therefore allow people to vote.

[02] ROLE OF UNPREDEP IN MAINTAINING PEACE AND STABILITY EMPHASIZED

The Macedonian radio reports that the Resolution stresses the great importance the Security Council attributes to the UNPREDEP mission in preserving peace and stability - concluding that security in Macedonia is constantly improving, but that the same is, however, not the case with the wider region.

According to A-1 TV even the Russian Federation UN Representative H.E. Amb. Sergey Lavrov (who abstained from casting his vote) stated yesterday that UNPREDEP had played a key role in preventing the escalation of the crisis in Ex- Yugoslavia, and in stabilizing the situation in Macedonia.

Lavrov, nevertheless, also stressed that now conditions in the region were entirely different and far more stable.

Based on the assessment of the Russian Federation, the UN mission in Macedonia is certainly to be terminated after 31st May next year, as otherwise there would be enormous possibilities for the success of the UNPREDEP mission to be threatened. With regards to the down-sizing of troops by one third Ambassador Lavrov said that Russia considered the number insufficient.

[03] DONOR CONFERENCE ON MACEDONIA NEXT FEBRUARY

Donations totalling 85 million dollars to be procured during this Conference, should settle Macedonia's foreign debts which is to affect the stabilizing of the country's economy considerably... said Vice-President Miljoski in an interview given for A-1 TV, after yesterday's talks in Brussels.

Vice-President Miljoski furthermore said that the possibility of signing the Cooperation Agreement between the EU and Macedonia (approved in June this year) had been discussed with Mr. Van Den Bruck. Currently this is being obstructed by the existing unsettled dues of 30 million dollars towards the European Investment Bank, though the enactment of the Agreement has been scheduled for the 1st January 1997. Miljoski stated that this debt could be settled after receiving the first installment of the ESAF- arrangement closed with the IMF. Should everything go fine, forecasts predict that the Cooperation Agreement between the EU and Macedonia could be enacted at the beginning of April `97.

A-1 TV reports that talks between Euro-Commissioner Van Den Bruck and Vice-President Miljoski outlined the technical issues concerning the Agreement's ratification which will make it possible for Macedonia to avoid using the FYROM reference.

[04] POLISH-MACEDONIAN TALKS FOCUS ON ECONOMIC COOPERATION

After the meeting Minister Frchkovski stressed that it had been agreed upon an intensifying of cooperation between expert teams of both countries with respect to legal succession, the networking of both Ministries of the Interior and the strengthening of economic cooperation.

Underlining the importance of Macedonia in the region as a country which has contributed greatly to a democratization of multilateral relations, Minister Rosati confirmed Poland's support for Macedonia's effort during its integration with the UN and the CEI. The Polish Diplomat also emphasized that a high level of concordance had been expressed concerning the achieving the both countries' common objectives: obtaining EU and NATO membership.

Today the Polish Head of Diplomacy is to be received by President Gligorov and PM Branko Crvenkovski.

[05] FRENCH MILITARY DELEGATION IN MACEDONIA

[06] DENIAL OF INFORMATION ON GREEK MILITARY AIRCRAFT VIOLATING MACEDONIAN TERRITORY

That very same day Macedonian border patrol units, as well as the Radar Control of the Macedonian Air Force registered another formation of 3 Greek military aircraft flying over Mount Kajmakchalan, near the border. This led to the immediate intervention at Regional Flight Control in Athens, which was followed by another flight over the mountain and the eventual withdrawal of the formation from the border, the Defense Dept. revealed.

[07] LANGUAGE COMPROMISE TO INCREASE ECONOMIC COOPERATION

The latter had been attended by businessmen from Bulgaria and Macedonia, as well as by Bulgarian Deputy Trade Minister Vladimir Krapchev.

Throughout the meeting it had also been stressed by Bulgarian Trade and Industry Chamber President Bozhidar Bozhinov that there is a need of reaching a compromise on the language issue, and it was suggested that the documents to be signed should be in English.

During the scientific meeting on Problems within Economic Transition in Macedonia and Bulgaria at the Macedonian Academy of Science and Art, attended by a large number of experts from both countries, it was concluded that among SE countries Macedonia has one of the smallest unemployment rates, whereas Bulgaria is breaking every record in terms of hyper-inflation.

[08] MACEDONIA OFFICIALLY FREE OF HOOF AND MOUTH DISEASE

Current endeavours are mainly directed towards the lifting of the ban on the export of lamb which above all applies to EU countries. According to Mac. representatives this issue has already been discussed with the Italian counterparts.

[09] SKOPJE - THE WORLD STUDENT CENTRE

`Vecher' reports that this decision has been brought about at the Conference of the European Students' Association and Other Continental Representatives in Brussels. This Conference also decided to stage the following IUS World Congress in Skopje, and besides this Dragan Pehchevski - member of the Mac. National Assoc. - was elected Head of the Social Policy Commission of the European Students' Association.

MILS SUPPLEMENT

[10] `Additional Insurance, Payments or Deductions'

(`Nova Makedonija' - 27th November 1996)

The Health Care of Macedonia needs to undergo serious reforms... this is something we have been hearing for ages.

It seems, however, that only recently the first concrete steps conducive towards the realization of this objective have been taken. Thus it has already become common knowledge that a project on transforming the Health Care sector, costing 19.4 million US $, is being outlined. 16.9 million $ are to be procured in shape of a credit given by the World Bank, i.e. the IDA (International Development Agency), whereas the remaining 2.5 million $ are to be provided by the Mac. Government.

The beginning of the project's implementation phase has been scheduled for January `97, while the actual reforms are to be conducted starting with June in Prilep and Ohrid as `experimental' municipalities. This has been preceded by the compiling of a problem analysis and possible solutions from July this year onwards up to recently. The problem analysis has been provided by experts of the US-based `Rand' Corporation (employed by the World bank) and domestic experts. Thus these analyses have already served as a foundation for a Study on the Macedonian Health Care system, which is to procure the ground for this project. This preparatory stage has been financed by the Japanese Government and funds not reallocated for this particular project. Currently this Study is still at a technical level - comprised of reports on five fields of interest: participation, the principle of paying for health care based on the `per capita payment principle' in primary health care, a basic package of services, an information system and a cost-efficiency study on the burden certain diseases generate for the population. All these packages have been outlined concordant to three criteria: expenditures should equal revenues, the Health Care Fund's balance sheet should not be negative and the Dept. of Health should prioritize those services proving to be most cost-efficient. `Although the findings of these analyses are still provisional, we continue our data-gathering which is conducive into an increased insight into the principal needs of the Macedonian Health Care system', says Ms. Ninez Ponce - an economics expert of the `Rand' Corporation working on the problem analysis for the Health Care System Reform Project. The reports of all five fields will be integrated into a package which is to represent a foundation of considerable substance, i.e. the final version of the problem analysis according to which the Health Care sector is to be reformed.

Ms. Ponce furthermore emphasized that the problem analysis would have to be compiled carefully and orientated towards its beneficiaries (the patients) and its target groups (public health institutions, its employees and the government). Thus the final drafts of the reports are to be circulated publicly, i.e. forwarded to all stakeholders such as the public health care organisations, the doctors, the Macedonian Medical Chamber, the Trade Union... and eventually to the Government and the Parliament which have to clarify whether legal provisions regarding this sector (i.e. Health Insurance) need to be changed, as this is most likely to be the case.

Another priority issue to be precisely defined - according to Ms. Ponce - prior to the implementation stage of the Project is the participation policy, as reforms in this field affect the patient directly. Based on the opinion of WHO experts (expressed in their report) this policy of participation is to be conducive to the decrease of demand in this sector. This will entail a reduction in providing services which are not urgent but indispensable. It is for example - Ms. Ponce pointed out - not sustainable to provide an x-ray for each case of respiratory organs difficulty.

Once this has been rationalized there will be more funds to be reallocated to the Health Insurance Fund.

Concerning the settling of this participation issue experts have proposed three options to be considered by all stakeholders within the health sector. These options represent three possibilities to control the demand of health care services. The first proposed option has become known as participation or additional insurance - which is currently being applied in our health care system and consists of the paying of a percentage of the overall cost for a provided service. The second alternative is another type of participation known as additional payment. In this case the patient pays a set amount for a provided service.

It has proved to be rather problematic, though, to determine the height of this amount. Should the latter be identical for a minor surgical intervention at - let' say - a dentist and a gynecologist? Thus Ms. Ponce considers the first option (additional insurance) more just to the patient, though they will never be quite certain how much the next visit to the doctor is going to cost them - as the cost represents a different percentage for each kind of medical service.

The third proposed option, which has also been implemented throughout the US, is known as deduction. `It is rather difficult to explain', Ms. Ponce continues. `At the beginning of the year a certain amount is being determined for each person covered by health insurance - and throughout the year deductions are being made of this fictional sum for each provided service.' To facilitate the understanding of this participation option, Ms. Ponce uses a concrete example: if this sum is to total 400 denars per annum for each person, and the latter has a check-up at his GP the amount of 30 denars will be deduced from the total of 400, and the patient will be left with 370 denars at his disposal. This continues until these 400 denars are spent... afterwards, if this person still requires medical treatment, payment will no longer be required as the person is most likely to be seriously ill and in need of help. It is the personal opinion of Ms. Ponce that if this participation model is chosen, it will become quite possible that the Health Insurance Fund is to become short of means, thus she advocates the second option (additional payment of a set sum) as the most favourable solution for the Health Care system in Macedonia. It would, however, have to be combined with the `per capita payment principle' at primary public health care institutions i.e. with the model of a permanent, family GP. Within this context it has also been stressed how important it is to retain the health insurance approach, which would entail a `status quo' of the percentage (8.6%) reallocated for this purpose from the gross personal income.

Ms. Ponce emphasizes that participation and the service package are those components of the reform which are to affect the patients directly, and the creating of an information system, the updating of administration procedures in order to improve the monitoring of health service demand, as well as the introducing of a permanent or family doctor - who will practically be in charge of the primary public health care funds - will entail reforms of the attitude of medical personnel.

(end)

mils news 29th November 1996

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