Macedonian miracle as eHealth system ends hospital waiting lists


An online booking system has helped Macedonia abolish waiting lists. The European Consumer Health Index shows Serbia is set to do the same - and others may follow

Macedonia’s online appointment-making tool has dramatically slashed waiting times for patients, prompting neighbours to adopt the system wholesale and pushing the former Yuogoslav republic up to 20th position of the 35 countries in the 2016 European Consumer Index, despite being among the poorest in the region.

“Macedonia is the biggest success story we’ve seen since launching the Index over 10 years ago,” said Arne Björnberg Chair of the Health Consumer Powerhouse, which compiles the ranking. “They have rocketed up the scoreboard since introducing the system in 2013 and have now eliminated waiting lists altogether.”

The system allows GPs to make appointments for their patients with hospital consultants or to book slots on diagnostic scanners such as MRI and X-ray machines. This significantly reduces the amount of downtime for specialists and fills up timeslots where expensive imaging machines would otherwise lie idle.

“The fantastic part is that they managed to get doctors to open up their booking calendars, which brings unprecedented transparency,” said Björnberg. “There are no longer any quiet Friday afternoons if there are patients who need to be seen.”

The impact has been so significant that the expert panel that produces the ECHI was initially sceptical. “We heard so much hype about this system that we had to visit Macedonia in person before we could score it,” Björnberg said. “But it’s for real and our patient survey confirms it.”

Healthy competition

The 2016 scoreboard, published on 30 January, shows that Serbia has recently embraced the same approach and it is paying off already. Ranking bottom of the league in the first two years it was included in the Index in 2012 and 2013, Serbian officials responded by hiring the team behind Macedonia’s IT system and licensing the software.

The system had an immediate impact on waiting times, helping Serbia rise to 23rd place, and the country is expected to push it even further up the ranking in the years to come.

Waiting lists are one of the key reasons that Sweden at 12th and the UK, 15th, remain outside the top 10. Björnberg said Macedonia and Serbia are showing that resources alone do not determine health system accessibility.

Lengthy waiting lists are bad for patients and needlessly inefficient. “It’s not well appreciated by policymakers that it’s more expensive to have people on waiting lists for months,” said Björnberg. “Politicians often suggest that patients don’t cost money while awaiting an appointment but this is simply not true. Governments who are disappointed with their ranking should look to low-resource countries that are getting the best bang for their buck.”

And the winner is…

Top of the pile this year is The Netherlands which scored 927 points out of a possible 1,000. Switzerland is a close second on 904 followed by Norway, Belgium and Iceland.

The Index finds that health systems in Europe are steadily improving across the board but there is still a significant gap between Northwestern Europe and countries in the east and southeast.

However, when it comes to getting value for money, lower-income countries fare better. The EHCI’s ‘Bang for Buck’ ranking shows the relationship between money spent and outcomes achieved. “Estonia and the Czech Republic have consistently offered good value for money and lately Finland and Portugal have joined this group,” the report says, adding that others are free to copy good practices if they want to be more cost-efficient.


At the other end of the spectrum Romania and Bulgaria are consistently inefficient. The Index finds that the tradition of long and expensive hospital stays is soaking up resources that could be better deployed elsewhere.

Overall, the improved performance of health system poses a welcome challenge to the EHCI’s methodology. Infant mortality and survival rates for heart disease, stroke and cancer are all getting better, while patient choice is developing well, according to the authors.


“As a growing number of European health systems start approaching the maximum EHCI score there will be a need to re-design the Index during 2017,” says Johan Hjertqvist, Health Consumer Powerhouse founder and president. “The complexity of patient-centred healthcare also challenges our assessment methods.”



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