Workers reap benefits from innovative State plan

The innovative Government Employees' Medical Scheme (GEMS) has grown in seven years to become SA's second largest medical scheme and it provides cover for 58 percent of eligible government employees or more than 1,7 million beneficiaries. Zava Colbert Rikhotso, chairman of GEMS, said that during last year the Scheme's membership increased by 14,5 percent to 595 737 principal members.

While the Scheme's growth was significant, he said, service had been maintained, which was demonstrated by the results of the annual GEMS member satisfaction survey, which indicated that satisfaction levels were at 84 percent. Rikhotso said that as many as 88 percent of members trusted that "GEMS would always be there to care for them and that the Scheme had their best interests at heart". He said during last year a number of member-focused projects were successfully implemented to build confidence in GEMS.

This included the further implementation of the scheme's translation plan, which endeavors to communicate to all members in their choice of any one of the 11 official South African languages. Dr Eugene Watson, former principal officer of GEMS, said the Scheme's efforts to ensure member satisfaction were bolstered by further growth of the Friends of GEMS service provider network, which now includes more than 12 000 healthcare practitioners in 22 000 practice locations around SA. He said that the GEMS Emergency Medical Services arrangement was successfully re-engineered, resulting in a significantly wider footprint and enhanced access for members.

Watson said low non-healthcare expenditure which, at 6,1 percent, was the lowest annual figure recorded to date since the inception of the scheme and half the industry average of 12 percent, served as an indication that costs were firmly in check despite the unprecedented growth of the Scheme. He said the Scheme performed significantly better than both the budget and financial targets that were approved by the Council for Medical Schemes for last year. The benefits of efficient contracting and the rigorous preferred provider arrangements are important in ensuring rational claims expenditure and added value for members.

During last year the scheme collected contribution income of R17, 4bn and incurred claims of R15, 6bn. In addition, it had a surplus of R549m and its solvency level rose 8,58 percent. Watson said corporate governance remained a key focus area with newly appointed trustees and a forensic structure that was enhanced by the activities of three new forensic investigation service providers.

Rikhotso said that as medical scheme that catered to the healthcare needs of South African public service employees, GEMS was fully committed to aligning its strategies to those of government. As a result, GEMS heeded the President's job creation call by implementing a client liaison business unit for a 12-month pilot period. An extensive recruitment drive was launched and 40 previously unemployed youths were appointed to staff the unit which, following an extensive training programme, commenced operations during the third quarter of 2011. He said that over the past seven years GEMS had grown steadily and developed into a central pillar in the sector.

Andrew Gillingham: Business Day, 20 June 2012