Heather McLeod

     

Body, Mind, Soul,

Earth

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Prescribed Minimum Benefits in South Africa

Healthcare Financing, Policy and Reform

The two key papers that led to the formulation and introduction of minimum benefits were those produced by Söderlund, Khosa and Peprah.

 

• Khosa S., Söderlund N., Peprah E. (1997) An Essential Package of Hospital Services : A Review of International Experience with Reference to South Africa, Centre for Health Policy Monograph Number 50.

 

• Söderlund N., Peprah E. (1998) An Essential Hospital Package for South Africa : Selection Criteria, Costs and Affordability, Centre for Health Policy Monograph Number 52.

 

• Guild R., (1994) Rationing Health Care Resources, unpublished MBA research report, University of the Witwatersrand.

 

 

The three reports below were the first costing of Prescribed Minimum Benefits (PMBs) in South Africa. The work was performed by a consortium of researchers. Subsequent costings of PMBs (2002, 2004, 2005, 2006 and 2007) were done as part of the work on risk equalisation.

 

There were three reports on the 2001 PMB pricing. The first deals with the pricing of the PMB diagnosis-treatment pair (DTP) package, as originally defined in 1999. The second deals with the costing of the (then) proposed CDL package which provides cover for diagnosis, treatment and medicine in respect of a list of chronic diseases. The third report combines the prices for the DTP and CDL components of PMBs and considers the impact on affordability of contributions for members of medical schemes.

 

Extensive slide and spreadsheet material was made available to stakeholders at the time and that historic material is available by e-mail from Heather McLeod.

 

• Fish T., McLeod H.D., Rothberg A., Eekhout S., Pels L., Innocenzi R. and Mubangizi D.B. (2002). The Costing of Existing Prescribed Minimum Benefits in South African Medical Schemes in 2001. Council for Medical Schemes, Pretoria.

 

 

 

• McLeod H.D., Rothberg A., Pels L., Eekhout S., Mubangizi D.B. and Fish T. (2002). The Costing of the Proposed Chronic Disease List Benefits in South African Medical Schemes in 2001. A Report prepared under contract for the Council for Medical Schemes, Pretoria.

 

 

• McLeod H.D., Mubangizi D.B., Rothberg A. and Fish T. (2003). The Impact of Prescribed Minimum Benefits on the Affordability of Contributions. A Report prepared under contract for the Council for Medical Schemes, Pretoria.

 

 

 

 

The paper below discusses the development of Prescribed Minimum Benefits and the need to extend PMBs to cover anti-retroviral treatment for HIV/AIDS.

 

•McLeod, H.D., Achmat, Z., & Stein, A.M. (2003). Minimum benefits for HIV / AIDS in South African medical schemes. South African Actuarial Journal, 3, 77-111.

 

 

 

 

• Discovery Health (2005) International Review of Basic Benefit Packages and a Proposal for a South African Benefit. Discovery Health, April 2005.

 

 

The Low Income Medical Schemes (LIMS) process recommended a separate minimum benefit package for LIMS options or schemes.  

 

• Broomberg, J editor. (2006) Consultative Investigation into Low Income Medical Schemes. Final Report. 7 April 2006.

 

 

 

Click on final report under "Low Income Medical Scheme Publications"

 

 

The Council for Medical Schemes embarked on an extensive process of consultation on a revised minimum benefit package.

 

 

 

See sections under "PMB Coded List", "PMB Definition Project", "PMB Review"

and "Prescribed Minimum Benefits".

 

 

The policy brief below summarises the developments in minimum benefits in South Africa and links the Prescribed Minimum Benefits in medical schemes to the norms and standards in the public sector. The issues for the design of a minimum package for National Health Insurance are discussed.

 

• McLeod, H. (2010) Defining the Benefit Package. NHI Policy Brief 10. 24 April 2010.

 

 

 

 

 

 

 

DTP Report 2001 pdf small CMS Publications SAAJ 2003 IMSA Policy Briefs IMSA Policy Briefs CDL Report 2001 pdf small Affordability Report 2001 pdf small CMS Publications