Government Employees Medical Scheme rated on par with SARS

Friday, 12 September 2014

The Government Employees Medical Scheme (GEMS), officially launched in January 2006, is an underrated state-owned centre of excellence on a par with SARS (SA Revenue Services), according to a case study released this week.

Undertaken by journalist Loraine Tulleken and editor Maureen Miller, the study researched the complex context into which the Scheme was born, its purpose, operational model and its socio-economic impact.

Among the 100 individuals interviewed as part of the study was Geraldine Fraser-Moleketi, who, as Minister for the Department of Public Service and Administration, championed the Scheme. Others included personalities who had been involved in the Scheme feasibility studies and development, industry leaders who had vociferously predicted the demise of GEMS, past and present service providers, academics, board members and executives.

Although GEMS specifically serves government employees, it operates within the same parameters as other schemes and is answerable to the Registrar and Council for Medical Schemes. It is the largest restricted scheme in the country, serving 1,85 million beneficiaries, and is second in size only to Discovery when open schemes are included. Several commentators have called GEMS ‘a game changer' for the industry.

Tulleken, who assures that the case study was never intended as a PR exercise, says, "Having written about the medical schemes industry for more than 20 years, I approached the study determined to unearth its weaknesses as well as its strengths. So I started with the Scheme's original detractors. ‘I was wrong' was a constant refrain. Indeed, several have emerged as service providers. Of course there were criticisms, but these tended to be constructive."

Miller, who conducted a dipstick survey of members across the five options offered by the Scheme, found that despite fairly predictable complaints, by far the majority would recommend the Scheme to other government employees.

One of the most surprising outcomes was the number of government employees who still don't believe a government-owned entity can set the bar within the private sector. This is despite the Scheme's phenomenal growth and ability to keep health costs 50% lower than the industry average.  

The study revealed that although GEMS is the only scheme to communicate in all 11 languages and conducts numerous onsite workshops within government departments, the lower-income-level employees the Scheme is trying hardest to reach are not being encouraged to attend by senior personnel. The more senior employees, probably comfortable with the open schemes they belong to, were viewed as about to become more receptive to moving, now that their contract period had been increased from three to five years.

Notably, the Scheme still has 37% of its potential market to woo.

In stark contrast to the non-believers within government, a number of private sector commentators ranked GEMS on a par with SARS. It is against this backdrop that several interviewees recommended a stronger external communications strategy to counteract the lack of appreciation for what the Scheme offers and what it has achieved.

Tulleken said another noteworthy response was the confidence shown in Principal Officer and Chief Executive, Dr Guni Goolab. "Within five minutes of nearly every interview, his predecessor, Dr Eugene Watson, was mentioned and much of GEMS' success was laid at his door. But the consensus was that while Dr Watson had been the man to lead the Scheme to operational maturity, Dr Goolab was well placed to take the Scheme into a new era of closer stakeholder relationships."

Across the board, GEMS was viewed as a model for the proposed National Health Insurance, but there were varying opinions on what its role should be. "The Scheme has been a pathfinder within the industry, having successfully developed the means to provide a broad cross section of members with meaningful health cover. Many commentators expect GEMS to continue playing this leadership role within the healthcare sector into the future," concluded Tulleken.