With preferred tender-bidders identified and enrolment set to begin in January next year, will the roll-out of the Government Employees Medical Scheme (Gems) address disparities in the healthcare sector or merely provide civil servants with top-quality medical care?
The Department of Health argues that, with the scheme in place, more public servants will pay for healthcare in public hospitals, generating income for improved services. However, critics contend that state employees may simply choose to use private facilities.
According to the Department of Health, 80% of South Africans have limited or no access to health services, and while the government spends R33,2-billion on health care for 38–million people, the private sector spends R43-billion on seven million people.
South Africa’s public hospitals are understaffed and overburdened, while, because of administrative weaknesses, provincial health departments are battling to spend their health budgets.
According to health department spokesperson Solly Mabotha, the rollout of Gems will mean civil servants who previously used free public health care will now pay for it, bringing much-needed funds into the public health sector and helping to raise the standard of care.
“When you say medical insurance, people always think private sector. We need to attract more people into the system so that they can pay for services and we can use the money to improve the public hospitals,” said Mabotha.
Sibani Mngadi, the health minister’s spokesperson said the department encourages all civil servants to use public hospitals and clinics. The minister had led by example by regularly using the Pretoria Academic Hospital and the Johannesburg Hospital.
However, civil servants will have the choice of seeking medical care at either private or public hospitals. Nurses working at Chris Hani Baragwanath Hospital could travel to a private healthcare facility for medical treatment — sidestepping the very services that they are responsible for providing.
Andy Gray, senior lecturer at the University of KwaZulu-Natal’s school of medicine, agrees that such a scenario is likely, despite appearing to be illogical. Gray stressed that if civil servants who previously accessed free healthcare through public hospitals moved to the private sector, it would free up capacity in the public hospitals for those who could not afford healthcare.
“What it could mean is a narrowing of difference between the public and private health sectors, through co-funding and reducing the number of people that depend on the public health sector,” said Gray.
The preferred member enrolment strategy will see the incremental enrolment of civil servants, with those who are currently not signed up to a medical aid policy being targeted first.
The Gems tenders run for three years and will be revisited once that period is up or when the scheme has signed up 200 000 principal members, whichever comes first.
Last weekend the Minister of Public Service and Administration, Geraldine Fraser-Moleketi, announced Medscheme as the main contractor, with preferred bidder status for two of the eight tenders (administration and managed care).
Other winners included Aid for Aids (HIV disease management), Qualsa (medicine clearing house), Prime Cure Health (service providers of Topaz and Sapphire), First National Bank (banking), Sizwe Ntsaluba (auditing) and Netcare 911 (ambulance).