1. Defining the Benefit Package
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 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

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

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

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: Fax:
Innovative Medicines SA (IMSA) Cell:
PO Box 2008, Houghton, South Africa

9. Professor Heather McLeod
Material produced for IMSA by
Professor Heather McLeod