Prescribed minimum benefits or minimum prescribed benefits?

On 1 January 2004 the government introduced the policy of Prescribed Minimum Benefits (PMBs) into the health care sector. This system obliges health care funders to cover fully a minimum of 25 conditions for all members of the medical aid scheme, regardless of the level of scheme. In addition, in terms of an amendment to the Medical Schemes Act, 1998 (Act No. 131 of 1998), health care funders were allowed to introduce managed health care protocols provided that these were developed on the basis of evidence-based medicine taking into account considerations of cost-effectiveness and affordability, and provided that provision be made for appropriate exceptions where the protocol has been ineffective or causes or would cause harm to the beneficiary without penalty to the beneficiary. Furthermore, if managed health care entails use of a formulary or restricted list of drugs, such formulary or restricted list must be developed on the basis of evidence-based medicine taking into account considerations of costeffectiveness and affordability, and must make provision for appropriate substitution of drugs where a formulary drug has been ineffective or causes or would cause harm to the beneficiary without penalty to the beneficiary. With this in mind I would like to comment on the implementation of the PMBs in relation to hypertension and also use a case study to illustrate the serious problems facing doctors trying to implement good clinical practice.