title: Implementation of patients' rights legislation in the Republic of Macedonia: gaps and disparities.
abstract: BACKGROUND
  Since its formation after the breakup of Yugoslavia, Macedonia has made major strides in formulating a framework for protecting patient rights through extensive legal reform. The impact of this reform had not been assessed before the work of this project.
  
  
  OBJECTIVE
  Within the context of a larger project on improving human rights in patient care, this paper provides an overview of patients' rights legislation in Macedonia and uses research, case reports, and other empirical information to highlight the gaps in the implementation of patients' rights legislation on the ground.
  
  
  RESULTS
  The Law on the Protection of Patients' Rights (2008) and attendant legislation governing health care provision and other aspects of the social contract in Macedonia provide extensive protections for the rights of patients in such domains as the right to access health care, the right to information, and the right to remedy. This legislation also outlines several new procedural channels to enable patients to vindicate their rights within institutional and governmental structures on the local and national levels. Data from a number of studies and case file reviews suggest, however, that the implementation of many key provisions is lacking, both in terms of quality and presence of services or mechanisms contemplated by Macedonian law. Gaps in implementation disproportionately affect vulnerable and marginalized groups, including women, rural residents, and Roma.
  
  
  CONCLUSIONS
  Although the letter of Macedonian law generally complies with international best practices in patients' rights, these rights are not fully implemented and the mechanisms implied are not fully functional. Additional investment must be made in monitoring systems, education, and incentive mechanisms to ensure effective implementation, including the formation of a mandated commission for the protection of patients' rights.
authors.affiliation: Human Rights in Patient Care Program at the Association for Emancipation, Solidarity and Equality of Women in Skopje, Republic of Macedonia.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Alcheva
authors.affiliation: Program Human Rights in Patient Care at the Centre for Regional Policy Research and Cooperation "Studiorum" in Skopje, Republic of Macedonia.
authors.forename: Filip
authors.initials: F
authors.lastname: Gerovski
authors.affiliation: Law and Health Sciences at the Northeastern University School of Law and Bouvé College of Health Sciences, Boston, USA and Adjunct Professor at the Division of Global Public Health, UCSD School of Medicine, San Diego, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Beletsky
mesh_terms: D022126:Access to Information / Q000331:legislation & jurisprudence; D000328:Adult; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence; D006806:Human Rights / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D061214:Patient Safety / Q000331:legislation & jurisprudence; D011315:Preventive Medicine / Q000331:legislation & jurisprudence; D018843:Republic of North Macedonia