National Health Insurance Policy Brief 10 Defining the Benefit Package 24 April 2010
PMB and Hospital Status PMBs account for 52. 7% of total benefits. In-Hospital benefits account for 54. 2% of total benefits. Source: Heather Mc. Leod using data from a large administrator for calendar 2008
PMB and Hospital Status by Age and Gender There is a strong pattern by age and gender. The Under 1 s are covered extensively by PMBs but the childhood years have the largest Non-PMB expenditure. Source: Heather Mc. Leod using data from a large administrator for calendar 2008
Oregon Categories with Effectiveness and Discretion Source: Discovery Health. International Review of Basic Benefit Packages and a Proposal for a South African Benefit; 2005.
Access to Essential Healthcare Proposed … Source: PMB review consultation document. Third draft 25 March 2009
Funder-driven Benefit Package Monitor provider behaviour Define package Price package and set fees Affordability after subsidies
Provider-driven Benefit Package Feasibility of provider delivery Define package Monitor quality Affordability after subsidies
Innovative Medicines South Africa (IMSA) is a pharmaceutical industry association promoting the value of medicine innovation in healthcare. IMSA and its member companies are working towards the development of a National Health Insurance system with universal coverage and sustainable access to innovative research-based healthcare. Contact details: Val Beaumont (Executive Director) Tel: +2711 880 4644 Fax: +2711 880 5987 Innovative Medicines SA (IMSA) Cell: 082 828 3256 PO Box 2008, Houghton, 2041. South Africa val@imsa. org. za www. imsa. org. za
Material produced for IMSA by Professor Heather Mc. Leod hmcleod@integratedhealingmbs. com www. hmcleod. moonfruit. com
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