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Defining the Benefit Package

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 McLeod using data from a large administrator for calendar 2008.

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Defining the Benefit Package

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  1. National Health Insurance Policy Brief 10 Defining the Benefit Package 24 April 2010

  2. PMB and Hospital Status PMBs account for 52.7% of total benefits. In-Hospital benefits account for 54.2% of total benefits. Source: Heather McLeod using data from a large administrator for calendar 2008

  3. PMB and Hospital Statusby Age and Gender There is a strong pattern by age and gender. The Under 1s are covered extensively by PMBs but the childhood years have the largest Non-PMB expenditure. Source: Heather McLeod using data from a large administrator for calendar 2008

  4. Oregon Categories with Effectiveness and Discretion Source: Discovery Health. International Review of Basic Benefit Packages and a Proposal for a South African Benefit; 2005.

  5. Access to Essential Healthcare Proposed … Source: PMB review consultation document. Third draft 25 March 2009

  6. Funder-driven Benefit Package Define package Monitor provider behaviour Price package and set fees Affordability after subsidies

  7. Provider-driven Benefit Package Define package Feasibility of provider delivery Monitor quality Affordability after subsidies

  8. 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

  9. Material produced for IMSA by Professor Heather McLeod hmcleod@integratedhealingmbs.com www.integratedhealingmbs.com

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