The Impact of PMBs on Affordability

Centre for Actuarial Research

The Impact of PMBs on Affordability

January 2003

Centre forActuarial Research

Approach to Affordability

Compare price of components of PMB package to reported benefits and contributions of medical schemes. Industry level Scheme level Option level

Compare price of PMB package to published contribution tables for open scheme options. Focus on low-cost options.

Compare price of PMB package to income levels of existing members and potential members of medical schemes. Impact of employer and per capita subsidies.


Price of the PMB Package


Cluster Analysis Different clusters experience different benefit utilisation,

costs and disease profiles. Provider behaviour differs by cluster, even within the same hospital facility.

Four distinct clusters: High contains options with older, 'whiter' members with

high utilisation; Medium-older contains options with medium utilisation

and older members; Medium-younger contains options with medium

utilisation and younger members; and Low contains options with younger, 'blacker' members

with low utilisation.


Cluster Analysis

8.8%

9.6%

10.1%

71.6%

High

Medium-older

Medium-younger

Low


Cluster Analysis Study contains more Low cluster beneficiaries than the

industry. For industry comparisons, use Weighted industry price.

This uses 50% of the costs of the Low cluster and 100% of the other clusters.

Low cluster is more relevant to the emerging low-cost option environment.

High cluster is used to give an upper limit to the PMB price. Would only be applicable to a few high utilisation options.


R 0

R 250

R 500

R 750

R 1,000

R 1,250

R 1,500

R 1,750

R 2,000

R 2,250

R 2,500

High Medium-older

Medium-Younger

High andMedium

Low TotalStudy

WeightedTotal

Pe

r B

en

efi

cia

ry P

er

An

nu

mNon-healthcare costsOutpatient packageUncertainty in PMB definitionInpatient PMB package

Price of Inpatient and Outpatient Package


Price of CDL Package

R 0

R 250

R 500

R 750

R 1,000

R 1,250

R 1,500

High Medium-older

Medium-Younger

High andMedium

Low Additional TotalStudy

WeightedTotal

Pe

r B

en

efi

cia

ry P

er

An

nu

m

Non-healthcare costs

Medical management est.

Uncertainty in CDL

CDL Medicine Package



Price of Complete PMB Package

R 0

R 500

R 1,000

R 1,500

R 2,000

R 2,500

R 3,000

R 3,500

R 4,000

High Medium-older

Medium-Younger

High andMedium

Low TotalStudy

WeightedTotal

Pe

r B

en

efi

cia

ry P

er

An

nu

mNon-healthcare costsCDL Medicine PackageAmbulatory PMB packageInpatient PMB package


Private Sector PMB Packageper beneficiary per annum

Price pbpa in 2001 Rand terms

HighHigh and Medium

Low Total StudyWeighted Industry

Inpatient PMB package R 1,994.95 R 1,591.46 R 867.47 R 1,073.31 R 1,188.01

Ambulatory PMB package R 477.24 R 416.72 R 308.12 R 339.00 R 356.20

CDL Medicine Package R 1,154.35 R 805.33 R 286.33 R 421.58 R 499.09

Non-healthcare costs R 170.96 R 141.97 R 89.55 R 104.82 R 113.47

Complete PMB package Private Sector

R 3,797.50 R 2,955.48 R 1,551.47 R 1,938.71 R 2,156.78


Non-Healthcare Expenditure on PMB Package

Non-healthcare Expenditure as a Proportion of …

HighMedium-

olderMedium-Younger

High and Medium

LowTotal Study

Weighted Total

Total Inpatient package 3.9% 4.0% 5.0% 4.3% 5.4% 4.9% 4.7%

Total Outpatient package 2.3% 2.3% 2.7% 2.4% 2.7% 2.6% 2.5%

Total CDL package 5.9% 6.8% 6.8% 6.4% 7.8% 7.3% 7.2%

Complete PMB package 4.5% 4.7% 5.4% 4.8% 5.8% 5.4% 5.3%

Well below Registrar’s benchmark of 10% of total expenditure


R 0

R 500

R 1,000

R 1,500

R 2,000

R 2,500

R 3,000

R 3,500

R 4,000

High Medium-older

Medium-Younger

High andMedium

Low TotalStudy

WeightedTotal

Pe

r B

en

efi

cia

ry P

er

An

nu

mPrivate sector costTotal CDL packageTotal Outpatient packageTotal Inpatient package

Public Sector Complete PMB Package


Public Sector PMB Packageper beneficiary per annum

Price pbpa in 2001 Rand terms

HighHigh and Medium


Total Inpatient package R 1,465.44 R 1,173.53 R 648.89 R 798.05 R 881.17

Total Outpatient package R 251.27 R 207.78 R 129.64 R 151.85 R 164.23

Total CDL package R 708.76 R 520.56 R 237.08 R 311.83 R 354.66

Complete PMB package Public Sector

R 2,425.48 R 1,901.87 R 1,015.61 R 1,261.73 R 1,400.07


Price of PMB Package by Age

0

2,000

4,000

6,000

8,000

10,000

12,000

0

1-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Mis

sing

All

ages

Pri

ce p

bp

a

Total CDL package

Total Outpatient package

Total Inpatient package

Complete PMB packagePublic sector


Price of PMB Package by Age

Note that for all age bands over 40, the PMB price by age exceeds the community-rated PMB price.

This explains the incentive open schemes have to attract and retain younger and healthier members.


Complete PMB Packagefor family of four per month

Price per family per month (2001 Rands)

HighHigh and Medium


Total Inpatient package R 556.37 R 466.84 R 291.98 R 345.27 R 373.29

Total Outpatient package R 98.28 R 84.98 R 59.00 R 66.93 R 71.09

Toal CDL package R 338.95 R 259.47 R 138.33 R 176.00 R 195.94

Complete PMB package Private Sector

R 993.59 R 811.28 R 489.31 R 588.19 R 640.33

Complete PMB package Public Sector

R 638.26 R 525.01 R 321.15 R 383.75 R 416.76


Affordability Relative to Benefits


Beneficiaries 2001

Open Schemes67.9%

Restricted Schemes

28.3%

Bargaining Council

Schemes3.8%

Source : Registrar’s Returns 2001


Hospital Only


624

854

1,4341,375

1,2531,339

R 0

R 200

R 400

R 600

R 800

R 1,000

R 1,200

R 1,400

R 1,600

PM

B L

owC

lust

er

PM

B In

dust

ryW

eigh

ted

PM

B H

igh

Clu

ster

Ope

n S

chem

es

Res

tric

ted

Sch

emes

All

Reg

iste

red

Sch

emes

Pe

r B

en

efi

cia

ry p

er

An

nu

m




Hospital and Related


1,046

1,414

2,342

1,9021,817 1,877

R 0

R 500

R 1,000

R 1,500

R 2,000

R 2,500

PM

B L

owC

lust

er

PM

B In

dust

ryW

eigh

ted

PM

B H

igh

Clu

ster

Ope

n S

chem

es

Res

tric

ted

Sch

emes

All

Reg

iste

red

Sch

emes

Pe

r B

en

efi

cia

ry p

er

An

nu

m




Medicine


286

499

1,1541,112

1,342

1,181

R 0

R 200

R 400

R 600

R 800

R 1,000

R 1,200

R 1,400

PM

B L

owC

lust

er

PM

B In

dust

ryW

eigh

ted

PM

B H

igh

Clu

ster

Ope

n S

chem

es

Res

tric

ted

Sch

emes

All

Reg

iste

red

Sch

emes

Pe

r B

en

efi

cia

ry p

er

An

nu

m




Total Benefits


1,462

2,043

3,627

4,4884,833 4,591

R 0

R 500

R 1,000

R 1,500

R 2,000

R 2,500

R 3,000

R 3,500

R 4,000

R 4,500

R 5,000

PM

B L

owC

lust

er

PM

B In

dust

ryW

eigh

ted

PM

B H

igh

Clu

ster

Ope

n S

chem

es

Res

tric

ted

Sch

emes

All

Reg

iste

red

Sch

emes

Pe

r B

en

efi

cia

ry p

er

An

nu

m




Affordability Relative to Contributions


Total Contributions


4,877 5,192 4,971

599433

549

1,551

2,157

3,798

R 0

R 1,000

R 2,000

R 3,000

R 4,000

R 5,000

R 6,000

PM

B L

owC

lust

er

PM

B In

dust

ryW

eigh

ted

PM

B H

igh

Clu

ster

Ope

n S

chem

es

Res

tric

ted

Sch

emes

All

Reg

iste

red

Sch

emes

Pe

r B

en

efi

cia

ry p

er

An

nu

m

Savings Contributions

Pooled Contributions




Non-Healthcare Expenditure 2001

Administration66.2%

Bad debts3.7%

Nett Reinsurance6.2%

Other 0.0%

Own facility cost0.0%

Managed Care18.4%

Broker fees5.4%




0

20

40

60

80

100

120

140

160

180

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Year

Rea

l Ran

ds p

mpm

(20

01 R

ands

)

Administration Bad debtsNett Reinsurance Other

Own facility cost Managed CareBroker fees

Real Non-Healthcare Expenditure

Source : Registrar’s Returns



Non-Healthcare Expenditure

752

496

676

--

-

169

110

11390171

5

R 0

R 100

R 200

R 300

R 400

R 500

R 600

R 700

R 800

R 900

R 1,000

PM

B L

ow

Clu

ste

r

PM

B I

nd

ust

ry

We

igh

ted

PM

B H

igh

Clu

ste

r

Op

en

Sch

em

es

Re

stric

ted

Sch

em

es

All

Re

gis

tere

d

Sch

em

es

Per

Be

nef

icia

ry p

er A

nn

um

Other Non-Healthcare

Administration and Managed Care921

501

786




Public Sector


1,551

2,157

3,798

5,475 5,625 5,520

1,400

2,425

R 0

R 1,000

R 2,000

R 3,000

R 4,000

R 5,000

R 6,000

PM

B L

ow

Clu

ste

r

PM

B I

nd

ust

ry

We

igh

ted

PM

B H

igh

Clu

ste

r

Op

en

Sch

em

es

Re

stric

ted

Sch

em

es

All

Re

gis

tere

d

Sch

em

es

Per

Be

nef

icia

ry p

er A

nn

um

Private Sector

Public Sector

1,016




Bargaining Council Schemes



624

1,046

286

78 106 78

R 0

R 200

R 400

R 600

R 800

R 1,000

R 1,200

Hospital only Hospital plus related Total Medicine

Pe

r B

en

efi

cia

ry p

er

An

nu

mPMB Low Cluster

Bargaining Councilschemes




1,4621,551

1,016

412471 471

R 0

R 200

R 400

R 600

R 800

R 1,000

R 1,200

R 1,400

R 1,600

R 1,800

Total Benefits Contributions Public Sector

Pe

r B

en

efi

cia

ry p

er

An

nu

mPMB Low Cluster

Bargaining Councilschemes



Total Benefits pbpm by Industry 2000

22.7

93.5

219.6

157.4

14.1

500.7

75.6

205.1

335.0

0

100

200

300

400

500

600

ClothingIndustry

BuildingIndustry

Motor Industry HairdressingIndustry

FurnitureIndustry

MEDCOR ElectricalIndustry (Cape)

Overall Exempt OverallRegistered

Industry

Ra

nd

s p

bp

m

34.3

Bargaining Council Schemes reporting in 2001

Low cluster PMB contribution for public sector in 2001

84.6

Exempt Scheme Benefits 2000



Total Benefits pbpm by Scheme 2000

21

26

32

26

23

51

29

99

128

42

187

87

344

203

36

40

10

76

501

205

335

0 100 200 300 400 500

Clothing Industry Health Care Fund (Cape Town)

Clothing Industry Medical Benefit Scheme (FS & NC)

Clothing Industry Medical Benefit Society (Northern Areas)

Clothing Industry Sick Benefit Fund (Natal)

Knitting Industry Medical Benefit Society (Northern Areas)

Bargaining Council for the Building Industry (Kimberly)

Building Industry Medical Aid Fund (Bloemfontein)

Building Industry Medical Aid Fund (Eastern Cape)

Building Industry Medical Aid Fund (Gauteng)

Building Industry Medical Aid Fund (Western Cape)

East London Building Industry Medical Aid Fund (ELBIMAF)

Autoworkers Medical Aid Fund (Automed)

Motor Industry Medical Aid Fund (MIMED)

Hairmed

Natal Hairdressers Sick Benefit Fund

Furniture & Allied Workers Sick Benefit Society(S.W.D.)

Natal Furniture Workers Sick Benefit Society

Electrical Industry (Cape)

MEDCOR

Overall Exempt

Overall Registered

Sch

em

e

Rands pbpm

Clothing Industry

MEDCOR

Furniture Industry

Hairdressing Industry

Motor Industry

Building Industry

Electrical Industry

Low cluster PMB contribution for public sector in 2001

Exempt Scheme Benefits 2000



Impact on Low-Cost Options


Options Available to Benchmark Family

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

Op

tio

ns

Contributions per family per month

R 640.33 per month Weighted industry PMB package for a family of four

Source : CARE Monograph



Primary Care Network Options

843

638

728

966

730

824

657

576

780

904

732

480

841

810

672

635

321

489

0 100 200 300 400 500 600 700 800 900 1,000

Fedsure Larona PrimeCure

Ingwe PrimeCure

Ingwe CareCross

Medihelp Nucleus

Medimed PrimeCure

Medimed ECIPA, UDIPA

Metropolitan Primary Plus

MSP/Sizwe PrimeCure

MSP/Sizwe Ecipamed

MSP/Sizwe MediCross

NMP PrimeCure

Protector Health Primary

Protector Health Primary Plus

Provia SilverCure

Spectramed Spectra Alliance

Topmed Bophelo Network

Vulamed Standard

Low cluster PMB Public Sector

Low cluster PMB Private Sector

Contribution per family per month

280




Recommendations for Low-Cost Option Design

Need contribution less than R500 for family of four earning R4 000 per month.

Hospitalisation offered in differential amenities in a public hospital.

Specialist services in a public hospital. Chronic medicine offered either in the public hospital or

with a strict formulary by the primary care providers. Primary care offered in private sector capitated networks.



Affordability Relative to Income


12.4%

28.9%

12.3%

14.7%

31.7%

<2000

2001-3000

3001-4000

4001-5000

>5000

Income Levels Open Schemes CMS Survey 2001

Source : Council for Medical Schemes


Employment Medical Scheme Beneficiaries

Employed44.0%

Missing or N/A29.0%

Not economically active24.7%

Unemployed2.3%

Source : OHS 1999



-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,0000

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Unemployed

Employed

Not economically active

Missing or N/A

Employment Profile Medical Scheme Beneficiaries

Source : OHS 1999



-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

0

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Retired (Pensioner)

Permanently unable to work

Not working

Not working (but looking for work)

Going to school/college/university

Full time homemaker/housewife

N/A


Workers Profile Medical Scheme Beneficiaries

Source : OHS 1999


47.1%

5.4%5.0%

7.4%

5.0%

13.5%

8.2%

4.6%3.7%

R0

Don't know or missing

R1-R799

R800-R1 800

R1 800-R2 499

R2 500-R4 999

R5 000-R9 999

R10 000+

Refuse

Income Levels Medical Scheme Beneficiaries

Source : OHS 1999


-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

0

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Refuse

R10 000+

R5 000-R9 999

R2 500-R4 999

R1 800-R2 499

R800-R1 800

R1-R799


R0


Income Profile Medical Scheme Beneficiaries

Source : OHS 1999



0%

20%

40%

60%

80%

100%0

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Refuse

R10 000+

R5 000-R9 999

R2 500-R4 999

R1 800-R2 499

R800-R1 800

R1-R799


R0


Income Proportion by AgeMedical Scheme Beneficiaries

Source : OHS 1999



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%R

0

R1

-R7

99

R8

00

-R1

80

0

R1

80

0-R

2 4

99

R2

50

0-R

4 9

99

R5

00

0-R

9 9

99

R1

0 0

00

+

Re

fuse

No

t g

ive

n

Public Sector

Not known

Medical Scheme


Income Profile All Citizens

Source : OHS 1999



0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

R0

R1-

R79

9

R80

0-R

1 80

0

R1

800-

R2

499

R2

500-

R4

999

R5

000-

R9

999

R10

000

+

Ref

use

Don

't kn

ow o

r m

issi

ng

Potential

Part of a medical scheme

Part of a medical scheme

Potential SHI

Public Sector


Possible SHI Income Earners

Source : OHS 1999


Affordability Issues for Pensioners


Vulnerability of Pensioners

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,0000

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Refuse

R10 000+

R5 000-R9 999

R2 500-R4 999

R1 800-R2 499

R800-R1 800

R1-R799


R0


Source : OHS 1999



Vulnerability of Pensioners Not in Medical Schemes

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

550,0000

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Refuse

R10 000+

R5 000-R9 999

R2 500-R4 999

R1 800-R2 499

R800-R1 800

R1-R799


R0


Source : OHS 1999



Vulnerability of the Disabled

-

1,000

2,000

3,000

4,000

5,000

6,000

7,0000

1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-45

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

+

(bla

nk)

Refuse

R5 000-R9 999

R2 500-R4 999

R1 800-R2 499

R800-R1 800

R1-R799


R0


Source : OHS 1999



Real Contributions

0

100

200

300

400

500

600

700

800

900

1000

1100

120019

7419

7519

7619

7719

7819

7919

8019

8119

8219

8319

8419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

01

Year

Ra

nd

s p

mp

m

Source : Registrar’s Returns



Future Pensioner Philosophy

7%

1%

6%

16%

60%

4%

12%

15%

26%

43%

0% 10% 20% 30% 40% 50% 60%

Eligibility CriteriaChanged

Cap Benefits

Cash or Benefits inlieu of Medical

Cap CompanyContribution

Do Not Offer Benefitsto New Employees

19992001

Source : OMHC Health Survey 2001


Conclusions


Conclusions on Affordability

Comparing actual benefit expenditure and contributions to PMB package: at industry level, PMB package was well covered.

There should thus be no upward pressure on contributions from Prescribed Minimum Benefits.

Comparing published options prices to PMB package: showed conclusively that the current packages on offer by open schemes were way in excess of the price of the PMB package for the industry. In some cases the prices were four or five times the price of the PMB package.


Conclusions on Affordability

The conclusion must be that there is substantial room to reduce the current benefit offerings in the industry to something closer to the price of the PMB package plus an additional amount for routine primary care.

The industry needs to critically examine benefit offerings for 2004 and begin the designs with a focus on the PMB package.


Further Research on Affordability

Calculate price of PMB package for each scheme using age profile of that scheme. Compare to community-rated price of PMB package.

Compare price of PMB package to disposable income of households.

Maximum proportion of income to be spent on healthcare. More information on employer subsidy policy. Impact of per capita subsidy, once shape of subsidy

finalised.


Policy Issues


Understanding of PMBs It has become apparent during this research that the

introduction of Prescribed Minimum Benefits with effect from 1 January 2000 has barely impacted the industry.

Very few schemes are able to isolate PMB expenditure from other benefits.

Of even greater concern is how few medical practitioners seem to have heard of PMBs. Thus at the critical interface with patients there is little knowledge of the rights of medical scheme beneficiaries to treatment for the PMB conditions.

It is certainly not in the interests of schemes to educate practitioners and this critical role must be taken on centrally by the Department of Health or the Council for Medical Schemes.


Community-rated PMB Price

The comparison of options prices in open schemes for the benchmark family shows a wide divergence of prices.

Members should be facing a common community-rated price for the PMB package and not a price determined by each scheme according to its own demographic profile and illness burden.

Now that a price has been conclusively determined for the PMB package for the industry, this can facilitate work on a risk equalisation mechanism between schemes that covers the benefits in the PMB package.


Vulnerability of Pensioners

From the study findings, it is evident that pensioners are already vulnerable and that they will increasingly find contributions to medical schemes difficult to afford, given that medical contribution increases have exceed pension increases.

Added to this is the changing structure of employee benefits in such a way that future pensioners will be unlikely to have a subsidy for medical benefits in retirement.

The study describes the subsidy issue as a future time bomb and this issue needs to be placed on the agenda now.


Impact of Per Capita Subsidy

No subsidyR 800 pa subsidy

R1 000 pa subsidy

No subsidyR 800 pa subsidy

R1 000 pa subsidy

Complete PMB Package Price pmpm in 2001

R 124.26 R 57.59 R 40.93 R 321.15 R 54.48 -R 12.18

Effective price to the member R 124.26 R 57.59 R 40.93 R 321.15 R 54.48 R 0.00

More than R10 000 1.1% 0.5% 0.4% 2.9% 0.5% 0.0%

R5 000 to R9 999 1.5% 0.7% 0.5% 3.8% 0.6% 0.0%

R2 500 to R4 999 3.0% 1.4% 1.0% 7.7% 1.3% 0.0%

R1 800 to R2 499 5.2% 2.4% 1.7% 13.4% 2.3% 0.0%

R 800 to R1 800 8.6% 4.0% 2.8% 22.1% 3.7% 0.0%

R 1 to R 799 27.8% 12.9% 9.2% 71.8% 12.2% 0.0%

Proportion of IncomeMonthly Income Bands

OHS99

Single Adult Family of Four


Per-capita Subsidy

The study also attempts to put into context the per capita subsidy mooted in the Taylor Committee report.

It was demonstrated that this subsidy could have enormous impact on the affordability of healthcare for low-income families.

This impact is subject to the final amount of the subsidy and the exact form it will take.

There is no doubt that a subsidy of this nature has a far-reaching impact on affordability of the PMB package for low-income groups and clarity on proposals is now needed.


Public Sector Contracting

The price of the PMB package in the public sector, which lies at the heart of affordability for the low-cost options and the Bargaining Council schemes, now needs further work by the public sector itself.

Medical schemes need to know at what price they can contract for the delivery of benefits in the public sector and these contracts need to be facilitated at a national level.

The impact of this additional substantial network to the current hospital networks offered by the private sector should have a galvanising effect on hospital benefit negotiations for 2004.


Total Expenditure on Prescribed Minimum Benefits

To put the size of the business in context, total expenditure on the PMB package using the Weighted industry price would have been R 14.573 billion in 2001.

The estimated price for delivery of the package in the public sector would have been R 9.460 billion.

This covers only registered schemes. A further amount of R 0.268 billion would be added to the

public sector total for those Bargaining Council schemes reporting in 2001.


A Research Unit of the University of Cape Town

(CARE)

Centre for Actuarial Research

A Research Report Prepared Under Contract for the Council for Medical Schemes

Documents

The Impact of PMBs on Affordability