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GEMS: making waves in healthcare funding

The Government Employees Medical Scheme (GEMS), spends less than 7% of member contributions on non-healthcare costs. Despite this the Scheme continues to provide quality, affordable healthcare services, which is underpinned by several new initiatives, to the more than 1.75 million South Africans who benefit from its services.

“Simply translated, this means that for every R100 GEMS receives in member contributions, the Scheme spends R93 on healthcare costs alone. In line with our commitment to ensure that healthcare services are totally accessible and affordable the contribution rates of GEMS’ benefit options have been maintained at 19% below those of similar benefit plans offered by other medical schemes. The benefits offered are however similar and in many instances better than that offered by other medical schemes,” notes Dr Guni Goolab, Principal Officer of GEMS.

“As a Scheme, GEMS has a tremendous impact on the greater South African healthcare industry. So much so that, of the funds spent on private healthcare, approximately 20% is spent by GEMS. At the same time, as much as 10% of all funds spent in the private and public healthcare sectors within the country is spent by the Scheme.”

“To ensure that the members of GEMS receive the healthcare they need when they most need it, Scheme members are not subjected to waiting periods. GEMS members are able to access their benefits the day they join the Scheme and late joiner penalties are not levied against members. This is to ensure greater accessibility for members and their extended families,” adds Dr Goolab.

GEMS was established in 2006 to provide public service employees with equitable access to affordable and comprehensive healthcare benefits. More than a decade later, the Scheme, which has received considerable acclaim as a pioneer in the South African medical schemes industry, continues to make a tangible difference in the lives of South Africans with 55.85% of eligible government employees now covered by the Scheme.

In October 2015 the Scheme introduced GEMS Fitness, a comprehensive, multicomponent workplace-based exercise and health programme. The overall aim of this important new initiative is to improve the health and overall well being of public sector employees while contributing to enhanced employee productivity.

 

“The GEMS Fitness programme is one of several new preventative healthcare measures introduced by the Scheme which aims to promote a healthier and improved lifestyle for our members.  We also offer a range of health screenings at wellness events across government departments throughout South Africa which has become a valuable awareness, monitoring and evaluation tool for the public sector,” notes Dr Goolab.

As part of the Scheme’s promotion of preventative healthcare screening services an array of new benefits along with a number of industry leading annual preventative care and screening tests were introduced in 2016.  These include:

  • Mammograms (breast cancer screening)
  • Bone density scans (to screen for osteoporosis)
  • Pap smears (a screening test for cervical cancer)
  • PSA tests (blood tests that can detect the early signs of an prostate cancer)
  • Occult blood screening (a test to check stool samples for blood, which may indicate colon cancer or polyps in the colon or rectum)
  • Glaucoma screening (an eye exam to detect glaucoma)
  • Influenza vaccines
  • Pneumococcal vaccinations

Dr Goolab adds that as part of the Shceme’s bid to ensure that members receive the best healthcare available, GEMS has put in place several efficient contracting agreements with healthcare service providers. The preferred provider arrangements with healthcare providers are of considerable importance in ensuring the long-term sustainability of the Scheme while adding considerable value for members.

“GEMS stands for affordability, ease of use and total accessibility,” notes Liziwe Nkonyana, Executive of Communications and Member Affairs of GEMS. “As a Scheme we are dedicated to meeting the needs of our medical scheme members, which means that it is imperative to fully understand our members and that which is important to them.”

“As a partner to Organs of State we work closely with government bodies, leading industry players and other stakeholders to put innovative methods and leading healthcare practices in place for the ultimate benefit of our members and the greater South African society.”

“Since the inception of GEMS we have made considerable strides in the greater healthcare industry. We are proud of the impact we have made and more specifically of the way that we have improved healthcare access for women employed within the public sector,” asserts Nkonyana.