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Member trust and confidence the hallmarks of a maturing GEMS

Published

2012

Thu

07

Jun

Seven years following its inception the Government Employees Medical Scheme (GEMS) has matured into South Africa’s second largest medical scheme and a force to be reckoned with. The Scheme now covers a total of 58% of all eligible public service employees, which equates to well over 1.7 million beneficiaries. Of these members more than 55% did not previously have access to medical scheme benefits.
 
Commenting on the GEMS Annual Report Mr Zava Colbert Rikhotso, Chairperson of the Scheme, noted that membership showed a pleasing 14.5% increase from 520 477 principal members at the end of 2010 to 595 737 at the end of 2011. GEMS has comfortably retained its status as the largest contributor to the overall growth of the medical schemes sector.
 
Rikhotso added that despite the extraordinary growth of GEMS the Scheme remains as committed as ever to providing members with the highest possible levels of service. “Testament to this were the results of the annual GEMS member satisfaction survey, which indicated that general satisfaction levels are at 84%. As many as 88% of members were found to trust that GEMS would always be there to care for them and that the Scheme has their best interests at heart. This talks to the heart of what GEMS represents and tangibly confirms that we continue to live up to our mandate of providing access to affordable healthcare benefits for public service employees.”
 
During 2011 GEMS was recognised for its service excellence by being ranked first in the medical schemes sector in the 2011 Ask Afrika Orange Index. 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 endeavours to communicate to all members in their choice of any one of the 11 official South African languages.
 
“The Scheme’s efforts to ensure member satisfaction were bolstered by further growth of the Friends of GEMS service provider network, which includes over 12 000 healthcare practitioners in 22 000 practice locations around South Africa. GEMS Emergency Medical Services arrangement was successfully re-engineered, resulting in a significantly wider footprint and enhanced access for members,” says Rikhotso.
 
“Our low non-healthcare expenditure, which at 6.1% is the lowest annual figure recorded to date since the inception of the Scheme and half the industry average of 12%, serves as an indication that costs are firmly in check despite the unprecedented growth of the Scheme,” adds Dr Watson, GEMS Principal Officer.
 
According to Dr Watson the Scheme performed significantly better than both the budget and the targets that were approved by the Council for Medical Schemes (CMS) in 2011. The benefits of efficient contracting and the rigorous preferred provider arrangements are of considerable importance in ensuring rational claims expenditure and added value for members. The 2011 results speak to the long-term sustainability of the Scheme.
 
During the year under review the Scheme collected contribution income of R17.4 billion and incurred claims of R15.6 billion. The Scheme recorded a surplus of R549 million for the period ended 31 December 2011 and its solvency level rose by 16% to 8.58%, which compared favourably to the solvency level approved by the Registrar of Medical Schemes.
 
Corporate governance has remained a key focus area of the Scheme. With newly appointed and elected trustees, the Board performed well.  The forensic structure was enhanced by the activities of three new forensic investigation service providers.
 
The annual independent service level audit was conducted and over 90% of audited service levels were complied with. All procurement processes were found to be transparent, fair and compliant to the supply chain management policy of the Scheme. The strength of GEMS governance measures was confirmed during a routine inspection by the CMS, which stated: “Overall, the Scheme must be commended for their achievement regarding proper governance principles. ”
 
“As a medical scheme that caters to the healthcare needs of South African public service employees, GEMS is fully committed to aligning its strategies to those of Government. With this in mind the Scheme heeded the call of the President for job creation in February 2011 by implementing a client liaison business unit for a 12-month pilot period. An extensive recruitment drive was launched during which approximately 13 000 curriculum vitaes were received. The Scheme then appointed 40 previously unemployed youths to staff the unit, which commenced operations, following an extensive training programme, during the third quarter of 2011.”
 
“Over the past seven years GEMS has grown steadily and developed into a central pillar in the sector. Our members consequently have a great deal of confidence that they can rely on GEMS in their times of need. We in turn remain as committed as ever to serving our members and broadening access to healthcare benefits that make a meaningful difference in the lives of public service employees,” concludes Rikhotso.

 
Source: Martina Nicholson Associates (MNA)
 
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