gems_logo_original

GEMS strategy to align with NHI roadmap

State medical scheme prioritises access at annual symposium

The journey towards universal healthcare access is gaining momentum, firmly supported by South Africa’s largest restricted medical scheme. This was one of the key messages to come out of the Government Employees Medical Scheme’s (GEMS) annual Symposium, which was convened in Soweto on Thursday.

Chairperson of the GEMS Board of Trustees, Ms Nontobeko Ntsinde, delivered the keynote address at the Symposium, outlining the priorities that GEMS will pursue in its strategic plan going forward.

“GEMS is an entity founded on the principles of equitable, affordable access, and with government being one of the key stakeholders, our position on NHI has remained resolutely to support its introduction and align the GEMS strategy going forward to the universal healthcare or National Health Insurance roadmap,” she explains.

“Our strategy for the next five years places greater emphasis on steering the healthcare industry towards universal healthcare. While it is important to continuously enhance GEMS’s operations to improve service provision and better health outcomes for members, we recognise that providing these in the long term requires bold moves to transform the healthcare industry.”

Held under the theme 10 years on: Towards universal healthcare – A case for primary healthcare provision and outcomes, the symposium brings together more than 400 local and international policy makers, academics, business leaders, funders, healthcare providers, healthcare scientists. The symposium aims to showcase some of the creative partnerships with various stakeholders that GEMS has harnessed to good effect in its first decade, and explores different perspectives towards the national goal of universal healthcare.

Ntsinde observes that Competition Commission’s recent market inquiry into the private healthcare sector indicates that the status quo is unsustainable. “Disproportionate healthcare spend between the public and private sector, gaps in affordability and accessibility, escalating costs and increasing claims patterns without the commensurate improvement in quality or health outcomes in a highly consolidated administration environment, means a major transformation is required in the industry.”

GEMS sought to break out of the traditional health funding paradigm to create models that will redefine how the healthcare system operates. “Partnering with organs of state, we will progressively look at ways of balancing quality, access and sustainability through active strategic purchasing and sourcing, as well as improving health disease management programmes,” she elaborates.

Ntsinde says that GEMS is uniquely placed to contribute its experience towards the realisation of National Health Insurance (NHI), having 1.8 million lives under its care with annual contributions totalling R30 billion and the lowest non-healthcare expenditure rate in the industry.

“GEMS’s mandate is not like that of a listed company, which is looking to provide returns for investors. Our duty is to provide social good to public service employees, making healthcare accessible to them and their families.

“The Scheme was set up as a precursor to the NHI; our model is supposed to chart the way for the nation’s healthcare provision as envisioned in the Constitution and the Freedom Charter,” Ntsinde concluded.