HBI 2021

New Vistas, New Opportunities

September 20-22, Westminster Park Plaza, London

Register to attend

    Become an HBI Intelligence member for £6,100/yr to read Macedonia, Tfyr Find out more
HBI Headline News You are an HBI Headline News Member
  • Country: Macedonia, Tfyr
  • Sector: All
  • Themes: All

Macedonia, Tfyr Market Report

For-profit health care market size in Macedonia, Tfyr 2020

€132m

Data generated using: Dialysis and Hospital (For-Profit)

Overview: Macedonia, Tfyr

For-profit health care growth

€ million 

For-profit health care sectors

Values 

Top companies revenue (2020)

€ million 
Search companies in Macedonia, Tfyr
North Macedonia's healthcare sector totals around €700m (2019) according to the World Bank, which says healthcare expenditure accounted for 6.6% of GDP ($12.5bn). Healthcare expenditure has risen in absolute terms over the years but fallen as-a-percentage of GDP, from around 9% in the early 2000s. 

Around €300m of this is out-of-pocket expenditure, 42% of the total, with the remaining €400m publicly funded through its compulsory health insurance scheme. Some of the €300m is from co-payments for services but a large part is also likely to be under-the-table payments. 

Primary care was entirely privatised in 2004-2007, and private hospitals have also been gaining a larger share of the acute care sector thanks to both private pay and health fund activity (see hospital report entry).

Macedonia, Tfyr: Dialysis

(Pre-COVID estimates in brackets) 2016 2017 2018 2019 2020 f/c2021 f/c2022 f/c2023 f/c
For-profit sector (€m) 1819202122232425
For-profit growth % 5%5%5%5%5%5%5%5%
Macedonia, Tfyr: For-profit market share of biggest operators
Rank Company 2020
Revenue in this sub-sector
2020
Total revenue
market share %
1 Diaverum €10m €825m 45%
2 Sistina Nefroplus €5.5m €5.5m 25%
3 Diamed - Special Hospital for Nephrology and Dialysis €4m €4m 17%
See all operators
€ million 
The dialysis market is split between global player Diaverum, which acquired the largest player PZU Diamed in 2019, and Sistina Nephroplus who have half and a third of the market respectively. Private hospital players won the remainder of nine-year public tenders put out in 2014. Nephroplus has common ownership with large hospital player Acibadem Sistina in Orca Holding, which owns minority stakes in both.

Macedonia, Tfyr: Hospital (For-Profit)

(Pre-COVID estimates in brackets) 2016 2017 2018 2019 2020 f/c2021 f/c2022 f/c2023 f/c
For-profit sector (€m) 758391100104 (110)108 (121)119 (133)131 (136)
For-profit growth % 10%10%10%10%4% (10%)4% (10%)10% (10%)10% (10%)
Macedonia, Tfyr: For-profit market share of biggest operators
Rank Company 2020
Revenue in this sub-sector
2020
Total revenue
market share %
1 Zan Mitrev Clinic €26m €26m 25%
2 Acibadem (IHH) €23.8m €554m 22%
3 Remedika Private Hospital €8.8m €8.8m 8.4%
4 Sante Plus €4.2m €31.5m 4%
5 PZU Hospital Plodnost €3.1m €3.1m 3%
See all operators
€ million 
Overview 

The Macedonian private hospital market is made up of several well-capitalised private hospitals and a clutch of smaller, mainly outpatient facilities, all in the capital Skopje. These groups serve the middle classes willing to pay cash to skip public hospital waiting lists for elective treatments but also do state-funded work in complex surgeries. 

The largest are Acibadem Sistina, part of the Turkish group owned by pan-Asian player IHH; Zan Mitrev Clinic, owned by the surgeon of the same name; businessman Mincho Jordanov’s Re-Medika hospital; and the IVF-focused Plodnost hospital led by fertility specialist Tashe Trpcevski. 

These four operators have a combined €70m in 2019 sales giving them a 70% market share of a market which is worth "over €100m" according to Dr Zan Mitrev, owner and general manager of the hospital of the same name. He tells HBI the market growing "relatively fast". Based on the above four's public financials the market had been growing in the high single digits up until COVID, around 10% a year. Zan Mitrev Clinic grew 35-40% in 2019 but fell 7% the prior year. 

Around 40% of his hospital's sales are from the national health insurance fund (NHIF), mainly cardiac surgery; 5% from private medical insurance and 55% from patients paying out-of-pocket. 

The quality of healthcare in the private sector is not universally of a high standard. Several hospitals and outpatient clinics have been made to close temporarily in the past few years because of patient safety scandals. Acibadem and fellow Turkish group Sante Plus also use facilities in Skopje as a referral stream to their centres in Turkey.

In February 2021, Dr Zan Mitrev clinic told HBI he was in discussions to sell a stake in the business.

He says that COVID more than halved his hospital's growth in 2020, from an anticipated €32m (+47%) to €26m (+20%). And his 2021 revenue forecast of €30m is still below the pre-COVID forecast for 2020. We reflect this slow recovery across the market in our figures. 

Most recent news about

Find Us