For years the South African medical schemes sector struggled to improve access to healthcare for South Africans. But much of this changed with the launch in January 2005 of the Government Employees Medical Scheme (GEMS), a medical scheme that has seen unprecedented growth since its inception.
“GEMS now covers over 1.5-million beneficiaries, which equates to almost 3% of the entire population of South Africa,” said GEMS chairperson, Professor Richard Levin. “This kind of growth is unheard of in the medical-schemes market and what makes us even more proud is that many of these beneficiaries were not able to afford medical scheme cover previously.”
According to Levin, who has been the Scheme’s chairperson for five years, it has been remarkable to witness the success of GEMS in providing public-service employees with healthcare cover. “Prior to the advent of GEMS, public-service employees did not have access to medical-scheme benefits that offered such value for money,” he said. “Now they have some of the finest benefits available at affordable rates.”
“GEMS promotes improved access to outstanding healthcare benefits, especially for lower- income earners,” said Levin. “The Scheme’s performance has been inspirational and sets an example to other employers by demonstrating that meaningful benefits can be made available to all employees.
“The need for the establishment of GEMS stems from the imperative of public service as a major employer in South Africa to protect, improve and support the health status of its workforce in a manner, and at a cost, that is justifiable to the citizens of this country. In GEMS, the employer has one of the most effective and efficient mechanisms at its disposal to proactively provide for a healthy and productive workforce and to support those employees who suffer from ill-health.”
Levin said that GEMS has broken “every record” in the South African healthcare-funding market. Among the reasons for this is the great emphasis the Scheme has placed on providing outstanding service to its members and in developing products that meet the needs of public service employees.
”GEMS concentrates on providing good core benefits and does away with superfluous frills, he said. As a scheme whose sole purpose is to provide affordable and accessible healthcare services to our members, we are committed to making every healthcare rand count.”
The Scheme also concentrates on ensuring that members understand their benefits and communicates with its members in a manner and in a language they are able to understand.
The needs and perceptions of members are all important to GEMS and its operations. A number of channels are provided through which members can communicate easily and openly with the Scheme. These range from feedback on service levels to suggestions regarding new benefits, services or other improvements. “We have worked hard to ensure that GEMS, despite its great size, does not become a faceless bureaucratic entity, but rather remains highly approachable and easy to communicate with,” said Levin. “Our impressive membership growth suggests that we are succeeding in this.”
GEMS has also implemented a number of initiatives to ensure that the Scheme’s benefits are easy to access and use.
Among these are the courier delivery of chronic medication, the sending of claims alerts by SMS, and ‘Friends of GEMS’, a registry of healthcare service providers that enables members to easily locate healthcare service providers in their area.
GEMS works to get members actively involved in the running of their Scheme, encouraging them to attend stakeholder meetings and AGMs, according to Levin. This is important and helps to ensure that GEMS is a Scheme that is “for its members and by its members”.
“We have now cemented our reputation as an industry pioneer that is always a step ahead of the rest of the market. As you well know, access to excellent healthcare benefits is one of the standard service conditions that employees expect from an employer of choice, which is what the public service is becoming as it continues along the road to its stated goal of reinvention.”