People Refuse To Pay to Family Physicians for Direct Primary Care


People Reject Proposal for Direct Primary Care

Too expensive, unusual, even impudent – this is how the Kumanovo residents have described the family physicians’ proposal for the patients to pay to be registered with family GPs. Recently, the Association of Private Physicians has submitted a request to the Health Insurance Fund to increase the capitation to 65 denars and for the patients to pay a fee of at least 30 denars to be registered with a family GP. Neither the poorer nor the wealthier Kumanovo residents agree with this proposal. Literally all of the respondents in the opinion poll that we have conducted oppose paying for direct primary care. However, they did not want their photos to be taken or their personal data to be written down because they believe that this would undermine their relations with their family physicians.

Forty-two-year old A.Dzh. says that, if this proposal is accepted, it will be fatal for her family. She is a social beneficiary because three generations of people are living in the same house, of which the youngest is 10 years’ old and the eldest is 66.


“We go to a doctor every single day. Either I go, because I am suffering from high blood pressure, or my husband, who is a diabetic, or my mother-in-law, who, as you know, has been having health problems for years. How can I afford to pay 30 denars every day or even 15 days a month? Make your own calculations, I do not have that much money”, the irritated 42-year old resident of the Kumanovo district of Bavchi tells us.

L.I., a single mother of two who works at a shoe factory, shares her view. She says that she does not intend to pay for her visits to the doctor.

“I rarely go to see a doctor, but my children are often ill. Sometimes it is serious, but most often they merely have a cold. However, I neither have the will nor the money to pay 30 denars. For example, if I pay 30 denars for a visit, plus 150 denars or even more for a medication, this will be too much for me, given that my monthly salary is 12,000 denars”, 34-year-old L.I. says.

Retired Kumanovo resident Todor B. says that he sees a doctor three times a week. He adds that his pension amounts to 12,500 denars, which they share with his wife, who does not receive a pension. If this expense is added, too, they would have no money for food because they already have to pay the bills and buy medications.


Twenty-eight-year-old K.D., an employed mother of a baby with a university degree, says that she has money, but she does not intend to pay for – as she puts it – a fictitious and unrealistic fee.

“It often happens that when I go to see a doctor I ask him/her a question, but the doctor ignores me. The examination is always short because there are always many people waiting and, honestly speaking, the doctors are not having a bad life. During weekends, they always travel abroad, which can be seen on their social media profiles, and they are off, unlike me: I always have to work on Saturdays because I work at a private company”, K.D. says.

The Family Physicians’ Association justify their request for direct primary care with the changes in the market economy and the increased expenses. They say that some of their colleagues have been forced to close down their practices, while others travel tens of kilometers to get to work. They say that they do not only pay for salaries and social contributions, but also for rent, supplies, firm registration fees and the like.

This association seeks an increase in the capitation from 55 to 65 denars. The surveyed people have a positive view on this request, though. They say that it is legal for the doctors to seek funds from the state, but not from the patients. They add that this is the people’s money, anyway.

Both the physicians and the public are waiting for the appointment of the new health minister to hear to his/her position on the doctors’ request.