61 Introduction In Macedonia, the necessity for reforms in all sec- tors, including health care, became apparent at the beginning of the 1990s as a consequence of the financial crisis that beset all former communist countries of Eastern Europe. When redefining the direction and strategy for the health care sector, the most important issue was a clarification of the role of the state and the role of the market in financing and providing the health services. Other issues included the transformation from centrally planned to market-oriented economies, reduction of state investments in the economy, together with the removal of several governmental controls, and extensive decentralisation [1,2]. Many aspects of the existing system were restructured, with the intention of creating an effec- tive oral health care system in Macedonia. Resource allocation was directed to those types of oral health care that were thought to be more cost effective (such as primary health care), reasonable distribu- tion of human resources and clinics, a regulated insurance system and a precise definition of the right to receive publicly funded oral health care, as well as establishing a market economy through the introduction of privately funded oral health care [3]. The Country and Health Insurance System The Republic of Macedonia is an independent, sov- ereign and democratic country in the middle part of the Balkan Peninsula in South East Europe. Macedonia is a former Yugoslav Republic and its independence dates from 1991, when parliamen- tary democracy was established as the political sys- tem. In 2009, the Macedonian population was 2,059,722, 57.8% of whom lived in urban areas. Many rural areas are deserted or their population is over 65 years of age. There have been significant changes in age bands among the population. In the period from 2001 to 2011 the percentage of young people (0-14 years) decreased from 21.5% to 17.2% and the percentage of the population over 65 years increased from 10.5% to 11.8% [4]. The country is administrated in 84 municipali- ties and the capital is Skopje. Data on ethnic origins from the 2002 census reported that 64.1% of the population identified themselves as Macedonians, 25.17% as Albanians, 3.95% as Turks, 2.66% as Roma, 1.78% as Serbs, 0.84% as Bosnians, 0.48% as Vlachos, and 1.04% others [5]. The per capita gross domestic product (GDP) for 2004 was US$ 2382. In 2005, the unemploy- Oral Health Care Provision Systems in the Black Sea Countries Part 14: The Republic of Macedonia Julijana Nikolovska 1 1 PhD, DDS. Docent, Faculty of Dental Medicine, University of St Cyrilus and St Methodius, Skopje, Republic of Macedonia. Corresponding author: Dr Julijana Nikolovska, Faculty of Dental Medicine, University of St Cyrilus and St Methodius, Vodnjanska 17, Skopje, Republic of Macedonia; e-mail: julijananikolovska@yahoo.com Summary This paper gives an overview of the development of health insurance and some aspects of the oral health care in the Republic of Macedonia since it became independent in 1991. First, it describes the provision of oral health care and treat- ments funded by the public health care system. The dental educational system and available epidemiological data are then described. Generally, few data are available about the dental workforce in recent years, especially regarding dental epidemiology. There are various specialisations in dentistry recognised in Macedonia, as well as three subspecialisations: implantology, maxillofacial and reconstructive prosthodontics, and prosthodontics for children. One aspect of particular interest is that there are many dental faculties in Macedonia and many dentists, relative to the population and the coun- try’s requirements. Key Words: Republic of Macedonia, Oral Health Care System, Dental Workforce, Dental Education