According to UN estimates, there are more than 2.2 billion people in the world who are poor or at the poverty threshold. The UN Development Program (UNDP), as the main causes of the rise in poverty, spells out the increase in food and wages, as well as the financial crisis and natural disasters.
The UN says basic social protection for the poorest in the world would cost less than two percent of world GDP.
The health system, according to the World Health Organization, is all stakeholders and activities whose primary goal is to promote, improve or sustain the health of citizens.
Organized health services are only one of many factors for maintaining good health, curing illnesses or ease of living. The basis of the health care system in the Republic of Macedonia is the primary health care oriented towards the individual, the family and the community, with an emphasis on preventive health care and satisfying the majority of the health needs of the population. Health is influenced by many factors from the external environment, environmental, social, economic as well as factors related to the lifestyle and other sectors of life. Keeping and promoting health is the main instrument in improving the health status of the population, especially vulnerable groups.
Currently, Europe faces a trend of increasing poverty and social exclusion, as well as deteriorating living conditions. About 125 million people are at risk of poverty or social exclusion in the EU, equivalent to 24.8% of the total population (Eurostat, 2014: 27).
Poverty reflects the failure of the system in providing resources and opportunities in a proper and fair way. This leads to deeply rooted inequalities and a huge contrast between those with enormous wealth at the expense of others who are forced to live limited and marginalized lives even though they live in a rich economic area. Experience shows that the crisis in the world had a devastating blow to countries where inequality is expressed and that have a weaker social protection system. Moreover, austerity policies and cuts in social services have increased the number of people living in poverty.
Debates on poverty in the EU are often closely linked to social exclusion. The term social exclusion serves to emphasize the process in which people are brought to the brink of society, with limited access to resources and opportunities, limiting their normal participation in the social and cultural life, whereby they feel marginalized, powerless, and discriminated. Due to its complex nature, the activity of health care and the health insurance system for each resident, especially for the state, is extremely important and in that sense high demands are imposed on all stakeholders who participate in it in any way.
The Constitution of the Republic of Macedonia states:
Article 9: The citizens of the Republic of Macedonia are equal in their freedoms and rights, regardless of gender, race, color of the skin, national and social origin, political and religious beliefs; property and social status.
Article 39: Every citizen is guaranteed the right to health care. The citizen has the right and duty to protect and promote his / her health and the health of others. “
The Constitution of the Republic of Macedonia, the international acts, the Law on Health Care, the Law on Health Insurance, the by-laws and other legal regulations should provide legal support for a guaranteed and sustainable health system, but the reality shows that there is no space for excessive normative optimism. Insufficient knowledge of the rights to health care and insurance for the majority of representatives of the Roma community most often constitutes an insurmountable obstacle and deepens the social gap and inequality and directly affects the poor health status of Roma and the general health condition of the entire population in the country. Due to all this, it is necessary to improve the access and quality of health care for socially excluded groups, as well as access to quality services for long-term care of socially vulnerable and excluded groups:
∙ Eliminate inequities in health care and ensure equal access to health care;
∙ Providing access to counselors for protection of patients’ rights in all stationary health institutions, and informing citizens of the existence of this institution, in accordance with the Law on Protection of Patients’ Rights
∙ Targeting the vulnerable groups in terms of rights in the field of health, and especially the right to non-discrimination, in cooperation with the competent institutions and the civil sector
∙ Improving access to health care for people without health insurance or appropriate personal documentation.
The Republic of Macedonia has a National Strategy for the Reduction of Poverty and Social Exclusion 2010-2020 in order to more efficiently plan the future activities for achieving the strategic goals, as well as to improve the situation and reduce discrimination. In the future, more successful work is planned in this field, as well as cooperation with most of the institutions that are crucial for reducing poverty and eliminating inequalities and ensuring equal access.