Scheme enthusiastic about the pragmatic strategy presented in the NHI Green Paper

Statement by the Board of Trustees of GEMS

The publication of the Green Paper on the National Health Insurance (NHI) by the Minister of Health on 12 August 2011 refers.

The Government Employees Medical Scheme (GEMS) is registered under the Medical Schemes Act as a restricted membership medical scheme for public service employees. The Scheme currently covers 575 000 principal members and more than 1 610 000 beneficiaries.

GEMS' establishment was informed by agreements between government, as employer, and public sector trade unions in the Public Sector Coordinating Bargaining Council and approved by Cabinet in 2004. The Scheme's founding policy mandate was to provide access to affordable and comprehensive healthcare benefits, and this remains its mission statement today.

GEMS is governed by a Board of Trustees, half of whom are appointed by the Minister for Public Service and Administration, and the other half of whom are elected by the members of the Scheme. The Board governs the affairs of the Scheme in the best interest of members.

In its five-and-a-half years of operation the Scheme has recorded phenomenal growth, its finances are well managed, a sound control environment is maintained and risks are mitigated, while innovative and effective membership services are rendered. GEMS has and continues to conduct the business of a medical scheme as provided for in the Medical Schemes Act but appreciates its role as a policy instrument of government that is aimed at improving the health and wellbeing of public service employees.

The Scheme views the Green Paper on the NHI as a laudable and highly positive step forward in the delivery of quality healthcare services for all South Africans.

The Board of Trustees congratulates the Minister of Health, the Cabinet and the Ministerial Advisory Committee on NHI on the publication of this watershed document. The Green Paper does well in emphasising the role of primary healthcare services in terms of illness prevention, the provision of treatment and the referral of patients and diseases to appropriate levels of care. In addition, the Green Paper sets out a sustainable process of redistributing the country's healthcare spend in an equitable manner both in terms of need and cost.

The inclusion of innovative solutions, such as the District Health Authorities, school healthcare services, specialist primary healthcare teams, the functional classification of hospitals and the emphasis on quality standards, is positive. Due care and consideration is given in the Green Paper to the sub-plans for important tasks in the roll-out of the NHI, which include the human resources plan, the legislative processes, the establishment of the NHI fund and the financing of the NHI. On closer review it is clear that equity, access, quality and the delivery of healthcare services are central throughout the Paper.

Fully cognisant of its role as a policy instrument of government, GEMS is confident that the NHI will be a success at both a functional and policy level and commits to supporting the implementation of NHI as mapped out by government. This support will be rendered unreservedly. It is appreciated that the NHI will be implemented in three phases spanning 14 years and GEMS pledges to render the technical, operational and strategic support required from the Scheme by government during this time. GEMS will continue to conduct the business of a medical scheme for public service employees until such time as its mandate changes.

The Scheme is enthusiastic about the pragmatic strategy presented in the Green Paper that will see sickness and disease treated, patients made better and the overall health of the citizens of South Africa improved in order to ensure a healthier, more productive nation.