1. PMB Review Update PO’s Forum
Dr O Modupe
Senior Manager: Clinical Unit

2. Consultative meetings
Stakeholders
Date
Consumers, Consumer Groups, Unions
24 July 2017
General Practitioners, Allied Professionals, and the corresponding Professional bodies
25 July 2017
Pharmaceutical and health technology
26 July 2017
Medical Schemes, Funders’ group
27 July 2017
Administrators, Managed Care Organisations, Brokers
28 July 2017
Specialists and the corresponding Professional bodies
31 July 2017
Hospitals, Hospital Groups
01 Aug 2017
Circular 42 of 2017 was published to invite stakeholders to the consultative meetings . The aim of the consultative meetings is to engage key stakeholders in discussions to finalise the structures and processes that will be used to drive the PMB Review
Consultative meetings between the CMS and different stakeholders took place from the week of the 24th August 2017 until the 01 August The aim of these consultation sessions was to ensure that there is a better understanding by all stakeholders regarding how the review process will unfold; and to get inputs and suggestions regarding the initiative as well as to make nominations for stakeholders representatives for the different committees. The table below is a summary of the stakeholders that were engaged on the review process.

3. Establishment of committees
Joint Steering Committee(CMS, NDoH, HPCSA, OHSC and other regulators)
PMB Review advisory committee
Clinical advisory Sub-Committee
e.g. Emergency Services X10
Costing Committee
Project Manager
Legal & Regulatory committee
Following the consultative meetings; the different committees were established; the PMB review advisory committee, the joint steering committee, legal and regulatory committee. The main purpose of the JSE is to ensure policy alignment. The main purpose of the PMB review advisory committee is to recommend a service benefit package and to identify measures that should be in place to ensure affordability and sustainability of the package. Clinical subcommittee will also be established which will look and specific services such a maternal and child health services.

4. Workshop Multi-stakeholder workshop: Purpose: 17 November 2017
Outline challenges with current review
Propose a way forward

5. Way Forward
Priority setting using the work that has been done by the CMS, NDOH and industry stakeholders that is relevant to the development of a service benefit package
Identify specific interventions that should be put in place to ensure that the specified health care benefits can be provided on a sustainable basis
Circular 6 of 2018 called for stakeholders’ inclusive input into a proposed wish list of service packages.
Development and adoption of a costing methodology for current PMB review

6. Way Forward Choose shape & select areas for further analysis
Priority setting:
Burden
Effectiveness
Undertaking costing & budget impact analysis
Publish for stakeholders' comments
Incorporate comments & make recommendations
Submit to the JSC
The first step is to decide on the structure of the new service benefits package, i.e. the categories of benefits to be covered.
5.2 The second step will be prioritising services to be covered based on the burden of diseases, effectiveness of interventions, acceptability and fairness of interventions while ensuring equity.
5.3 The third step will be costing and budget impact analysis of the prioritised list as well as assessment of health technologies were required. This will be followed by deliberations on the outcomes of the analysis and recommendations.
5.4 The recommendations will then be published for stakeholders’ inputs.
5.5 Inputs from stakeholders will then be incorporated in the final recommendations and submitted to the joint steering committee.

7. PMB Code of Conduct Latest draft published for public comments
Comments/inputs closed end of February 2018
Task team meeting will be convened to consider latest round of comments

8. THANK YOU