Prescribed Minimum Benefits–Quagmire Or Foundation for Social Health Reform?(Special Article)

Prescribed Minimum Benefits--Quagmire Or Foundation for Social Health Reform?(Special Article)

The concept of a minimum level of care is central to the facilitation and achievement of a more equitable and efficient quality health care system in South Africa. The National Health Act (1) mandates that ‘the Minister must, within the limits of available resources ensure the provision of such essential health services, which must at least include primary health care services and equitably prioritise the health services that the State can provide’. The Department of Health inquiry into a system of social security for South Africa concluded that government policy needs to provide a framework that ‘results in cover for a minimum level of essential health benefits irrespective of whether it is provided in the public or the private sectors’. (2) This need for a basic package of care is further endorsed by the draft Health Charter. (3) Although various government initiatives have defined essential services, the Prescribed Minimum Benefits (PMBs) as provided for by the Medical Schemes Act have had the greatest prominence. (4) Not only are they legislated, but they are the envisaged platform for the social health insurance package which is to be pre-funded by all earning above a given threshold, and which will define the entitlement for any person contributing towards such insurance. The aim of this article is to elucidate the core package approach in South Africa and to focus more specifically on the appropriateness of pursuing the current PMBs as the platform for social health reform. Defining essential care

Prescribed Minimum Benefits--Quagmire Or Foundation for Social Health Reform?(Special Article)

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