Health Insurance Fund proposes shorter sick leave; doctors object

The Health Insurance Fund of the Republic of North Macedonia (FZOM) has proposed changes to the sick-leave rulebook that include shortening certain sick-leave intervals and stepped-up checks of insured persons, drawing sharp criticism from parts of the medical community.

Doctors warn administrative rules may override clinical judgment

Under the planned changes, some sick-leave periods would be reduced by two days (from seven to five) and FZOM-appointed inspectors would be given a formal role in verifying whether people on sick leave are at their registered address. If an insured person is not found at home, they would receive a letter ordering them to appear before a medical commission and to explain their absence, FZOM says the measures aim to prevent abuses.

Many physicians told reporters the proposal appears rushed and wrongly prioritizes administrative procedures over individualized clinical assessment. "Will administrative procedure be imposed over the professional judgment of doctors?" asked Dr. Dobrila Andonovska, Specialist in Plastic and Reconstructive Surgery, on Facebook.

Surgeons and other specialists pointed out that recovery after an operation varies from patient to patient and that fixed time frames cannot replace a treating physician's assessment. Dr. Andonovska posed a question frequently raised by clinicians: "How relevant can the assessment of a commission composed of physicians who are not specialists in the patient's specific condition be?"

Another objection focuses on the composition of the commissions that will review temporary incapacity for work. "Within the Health Insurance Fund system there exist 'improvised' first- and second-instance medical commissions for assessing temporary incapacity for work. In the rules that define their composition, occupational medicine is not listed as a mandatory specialty! Where it is decided whether a worker is fit or unfit for a particular job, the specialty whose primary field is fitness for work does not have a system-guaranteed place. Strange, isn't it…" wrote Dr. Ilcho Efkoski, Specialist in Occupational Medicine, on Facebook.

The Medical Chamber said it will withhold comment until it receives and analyses the full rulebook. The left-wing party Levica criticized the measures as an extra burden on workers already facing insecure jobs, low wages and pressure from employers.

FZOM's proposed changes must first pass the fund's management board and then receive approval from the Ministry of Health before taking effect. Supporters of the reform say the new controls are needed to curb misuse of sick leave, while critics warn they could undermine doctors' authority and lengthen bureaucratic procedures for genuinely ill patients.

Photo: press material from the event