GEMS’ private healthcare benefit criticised in light of NHI

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Trade union Solidarity has criticised the recent decision by the government’s biggest medical scheme to guarantee private hospital care to all its members, saying it was an admission of the state’s failure to run an effective public healthcare system. Business Day reports that last week the Government Employees Medical Scheme (GEMS) announced that even its lowest-paid members would from January 2020 have cover for private hospital admissions, as part of its efforts to standardise the benefits across its different options.

Solidarity said: “While Solidarity welcomes the decision itself and believes that all South Africans should have access to private medical care, (it) sheds light on the state’s incoherent behaviour which, on the one hand, regards National Health Insurance (NHI) as a highly necessary intervention, but then negotiates access to private services for their own officials.”

“It is ridiculous that the state wants to place the lives and health of all South African citizens subject to a system they do not even trust with their own health. The message is clear: It will be public healthcare for you, but private healthcare for those working in the state,” said Morné Malan, senior researcher at the Solidarity Research Institute.

According to an earlier BusinessLIVE report, the move by GEMS to expand core private hospital cover is in line with the Competition Commission’s health market inquiry, which recommended an industry-wide standard benefit package. It also has the potential to reduce the load on the overstretched public health system by using spare capacity in the private-hospital market.

The report quotes GEMS principal officer Stan Moloabi as saying that the development is expected to make medical scheme membership more attractive to lower-paid civil servants, most of whom are not covered.

Solidarity further confirms their continued opposition to the nationalisation of healthcare by means of the NHI, which will place all services in the hands of the state – whose own officials do not even want to make use of public healthcare.

“It is ridiculous that the state wants to place the lives and health of all South African citizens subject to a system they do not even trust with their own health. The message is clear: It will be public healthcare for you, but private healthcare for those working in the state,” Malan is quoted in a report carried on the Politicsweb site as saying.

“The state cannot drive healthcare. It is time for them to stop doing that. Expanding the state’s involvement to a point where they manage everything, will only bring everything to a failure and bring about disastrous consequences,” Malan concluded.

GEMS has reinvested close to R1bn to enhance benefits for members for 2020, Fin24 reports it said. GEMS, the country’s largest restricted medical scheme, has over 720,000 principal members and over 1.8m beneficiaries, according to Moloabi.

Parliament recently heard that in 2017 GEMS had a market share of 46%. The scheme has now announced a weighted average contribution increase of 7.69% across all its benefit options. According to GEMS, this is the second year in a row, that it has kept its contribution increase one of the lowest in the industry.

The report says earlier last week, the Institute of Risk Management South Africa for the second year in a row awarded GEMS for outstanding risk management in the healthcare sector. The scheme was recognised for its leading Claims Management Forum. GEMS has developed a comprehensive risk management plan that has enabled the scheme to reach the 25% statutory reserve requirement while improving the financial stability of the scheme in less than three years.

BusinessLIVE report

BusinessLIVE report

Report on the Politicsweb site

Fin24 report

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