There is a need to revise the PMBs. The benefit structures of existing products in the industry, together with the legislated PMBs place a significant emphasis on hospital and specialist services, thus influencing healthcare utilization. A revision of PMBs will help contain costs and align them to the provisions in the National Health Act. BHF has proposed an “Essential Healthcare Package” for consideration by government. This recommends a set of revised PMBs, including primary care components compiled from DoH Norms and Standards of Health Clinics which are used in the district health system. These should replace the current PMBs for medical scheme beneficiaries. The proposal also considers recent policy developments which focus on designing an essential benefit package which is intended to provide a safety net for all and which should at the very least, provide a minimum acceptable standard of care while still allowing the principle of buy-ups and other funding mechanism to higher levels of care.

Norms, standards and practice guidelines for primary oral health care
Development of an Essential Healthcare Package (EHP) proposal for Medical Aid Schemes in South Africa’s transition towards SHI
Prescribed Minimum Benefits – Legal Analysis
The Primary Health Care Package for South Africa – a set of norms and standards
EHP and LIMS: Outpatient drug medicine benefit
Essential Medical Equipment List
Issues with the current PMB
Norms and standards
Primary oral healthcare