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

PMB and Hospital Status by 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

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

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

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

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