MINI REVIEW article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1646870
This article is part of the Research TopicChanging Healthcare through Innovation in Clinical Management and Healthcare Policy Strategies: Focus on Quality Improvement for the PatientView all 9 articles
Toward value in healthcare:Opportunities and challenges for implementing Value-Based Healthcare inNorth Macedonia
Provisionally accepted
Aleksandra Grozdanova*
Evgenija Mihajloska
Zorica Naumovska
Marija Staninova StojovskaZoran SterjevAleksandar DimkovskiKaterina Ancevska-Netkovska- Faculty of Pharmacy, Saints Cyril and Methodius University of Skopje, Skopje, North Macedonia
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Objective: European healthcare systems face increasing pressures from ageing populations, chronic disease burdens, and rising costs. North Macedonia experiences similar challenges, including workforce shortages, limited economic growth, and persistent health inequalities. Although reforms such as the Diagnosis-Related Group payment system and the development of an e-health platform represent progress, major gaps remain: low public funding, high out-of-pocket spending, weak primary care, and poor data integration. This review analyses Value-Based Healthcare implementation in selected European countries and assesses the current state of the Macedonian health system to identify challenges and opportunities for Value-Based Healthcare. Methods: A two-step narrative approach was applied. Peer-reviewed literature on Value-Based Healthcare implementation in European countries was retrieved from PubMed, Scopus, and Web of Science, complemented by case studies and EIT Health handbook. To evaluate North Macedonia, policy documents and reports were reviewed from the World Health Organization, the European Observatory on Health Systems and Policies, the European Commission, and national authorities, including the Health Insurance Fund, the Institute of Public Health, and the Ministry of Health. Evidence was synthesized thematically across financing, digital infrastructure, outcome measurement, and governance. Results: Examples from Spain, the Netherlands, and Germany demonstrate the benefits of outcome measurement, integrated care delivery, and innovative payment models. Experiences from Bulgaria and Slovenia, with comparable health systems, provide additional lessons. Conclusion: Value-Based Healthcare implementation in North Macedonia will require greater public investment, stronger primary care, standardised outcome measurement, and robust digital infrastructure. Prioritising value-driven, patient-centered reforms could strengthen performance, equity, and sustainability.
Keywords: Value Based Health Care (VBHC), North Macedonia, health system reforms, Health system sustainability, patient centered
Received: 16 Jun 2025; Accepted: 30 Sep 2025.
Copyright: © 2025 Grozdanova, Mihajloska, Naumovska, Staninova Stojovska, Sterjev, Dimkovski and Ancevska-Netkovska. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aleksandra Grozdanova, agrozdanova@ff.ukim.edu.mk
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.