FZOM proposes five-day sick leave; doctors and unions raise objections

Health Insurance Fund (FZOM) announcements about home inspections and a plan to shorten sick leaves that family doctors can issue from seven to five days have drawn criticism from physicians, unions and health experts. Medical professionals warn that a blanket five-day limit could harm patients and that the proposals lack evidence and detailed analysis.

Data and doubts from the field

Former FZOM director Nikola Panovski said there is no professional justification presented for cutting the period from seven to five days. "For a diagnosis like the flu, seven days are the minimum. Five days are dangerous for health, because the worker may return to work not fully recovered. With such an administrative measure, serious harm to health can be done," Panovski warned.

Doctors' associations argue that the duration of sick leave must be tailored to the diagnosis and the patient’s overall condition. "There are diagnoses for which a worker must stay home more than five days, especially if they perform heavy physical work. A worker with dizziness who is not fully recovered cannot return to operate a crane or work in construction," said Dr. Valentina Mitrova of the Association of General Practitioners.

The Union of Trade Unions of Macedonia (SSM) emphasized that compensation during temporary incapacity for work is regulated by collective agreements in both public and private sectors and said any changes must go through social dialogue. The left-wing party Levica announced it will oppose the proposed rules and intends to push for legislative safeguards so sick-leave rights are set in law rather than by sub-legal acts of the Fund. "There is undoubtedly abuse in sick leave and in the mechanism of sick leave, but we cannot, because of that, introduce measures that treat every worker as a potential abuser," said MP Amar Mecinovic.

According to FZOM, inspectors will perform home checks after an employer's report or at random and will verify whether insured persons are using sick leave for treatment or abusing absence from work. "If the inspector does not find the person on sick leave at home, in that case he leaves a document by which the person is summoned before the relevant medical commission to explain why they were not at home. The employer will also be informed about the case," announced recently FZOM director Zlatko Perinski.

Controls carried out in the Ministry of Interior in March 2026 uncovered a number of irregularities: inspectors reviewed 80 insured persons with a total of 514 sick leaves, finding irregularities for 29 people and deeming 100 sick-leave cases improperly issued or irregular. Ten of those with irregularities had changed their family doctor while on sick leave. Penalties totalling 1.2 million denars were imposed on public and private health institutions.

Health experts and former officials say the focus should be on clear analyses and better-targeted mechanisms to curb abuse without undermining patients' privacy or doctors' professional discretion. As former health minister Dragan Danilovski put it, "If the aim is to reduce abuses of sick leave, that is a perfectly legitimate goal. But it must be known what the real extent of the abuses is and whether the analyses have shown that the five-day period is the best solution."

Photo: press material from the event