In search of lasting service excellence in healthcare

It speaks volumes about a medical scheme and its service levels when surveyed members unequivocally state that the one aspect that they value the most about their medical scheme is its service excellence.

The Government Employees Medical Scheme (GEMS) has been at the cutting edge of many new trends in the South African medical schemes environment.  For example, when it first opened its doors for business in 2006 few expected it to be the unqualified success that it has turned out to be.

In the words of Prof Richard Levin, Chairman of the GEMS Board of Trustees:  "GEMS remains a text book role model medical scheme that continues to exceed every expectation. In terms of member growth it has no equal in the South African healthcare environment, and yet despite its considerable growth member satisfaction levels remain as impressive as ever."

To its credit, GEMS has taken every measure to ensure that its service levels would remain in a league of their own. These efforts have had an encouragingly positive result, so much so that the scheme has continued to grow in leaps and bounds while service levels have remained impressive. 

Just how impressive is evidenced by the pleasing results of a recent survey conducted among 2 000 GEMS members.  Of those surveyed 80.4% indicated that they were "very satisfied" with the services of the scheme while 81.3% rated staff members as being friendly and caring.  A further 80.5% of those surveyed viewed the staff as knowledgeable and professional. 

When those who were surveyed were asked what they liked the most about GEMS they said that it was the good service of the scheme that held the greatest appeal for them while the affordability of GEMS was rated second. 

Even though the GEMS call centre had to field well over 2.7 million calls from members during 2008, call centre agents were nevertheless rated a high 77.8% in terms of their "caring and understanding" while they also scored a high 72.1% when it came to resolving queries quickly and efficiently. 

When it came to face-to-face interaction with the medical scheme the GEMS walk-in-centres were rated high in terms of the positive experience of members - especially with regard to competence and attitude of staff.  More than 78.2% of respondents found the walk-in-centres easy to get to while 82.2% rated staff as friendly and caring and 80.1% saw them as knowledgeable and professional.  

What is encouraging is that despite the considerable growth of the scheme during 2009 members now rate the service of GEMS a little higher than what they did last year when the scheme's inaugural member satisfaction survey found that 79% of members surveyed were satisfied with GEMS while 50% were delighted with the overall service experience.  This demonstrates that the results of the research are not simply filed away but that active measures are taken to address each issue highlighted be it positive or even just potentially negative.

The result of this service excellence has had a marked impact on membership growth levels which have grown by an impressive third or 100 000 members.  The scheme now has well over 420 000 principal members and provides healthcare cover to well over a million individuals - or over 2% of all South Africans.  What is more, over one-third of all eligible public service employees are now enrolled on GEMS while over 50% of GEMS' members previously did not access the employer subsidy for medical schemes.  This means that in excess of 500 000 people who did not previously have healthcare cover now do.

Another important reason for the success of GEMS is its unrivalled innovation and ability to design and implement benefits and services that meet and exceed the needs of its members. Despite the many successes achieved by GEMS the management of the scheme also knows all too well that they cannot sit back and rest on their laurels. In so doing the key focus of GEMS is on providing members with "Access to excellent healthcare that is both affordable and administratively efficient".

It is with this philosophy in mind that GEMS complete regular surveys in order to assess service and to research the opinions of individual Government departments, members and service providers. The needs and requirements of members are of utmost importance to the scheme and feedback is always appreciated and acted upon. For example, there is a dedicated ‘suggestion' email address ([email protected]), which gives members an efficient avenue to communicate their suggestions to the scheme.  A great many good ideas are received and implemented in the process.