Public Service and Administration Deputy Minister, Dr Chana Pilane-Majake, said at 5.4% of contribution income, the 2023 Government Employee Medical Scheme (GEMS) non-healthcare costs are expected to remain significantly lower than that of other schemes.
Speaking at the National Council of Provinces Policy Debate on the Ministry for Public Service and Administration (MPSA) Debate in Cape Town today, Dr Pilane-Majake said: “GEMS’s core strategy is to improve affordability and access to quality healthcare for public servants, at a minimum cost possible.
GEMS do not get direct funding from the government. However, the government does contribute and subsidize medical contributions by its employees. The estimated total contribution income for 2023 is R48.08 billion.
According to the Deputy Minister, about 4.4% (R2.125 billion) of this amount is dedicated to operational issues.
At 5.4% of contribution income, Deputy Minister Pilane-Majake said the 2023 GEMS non-healthcare costs are expected to remain significantly lower than that of other schemes.
She said this enables GEMS to spend far more on healthcare provision than on operations and other issues.
“It is partly for this level of operational efficiency that the scheme was able to attain a surplus of R1.14bn for the 2022 Financial Year. This increased the GEMS reserve ratio to 48.95%, and is much better than the scheme budget of 41.42%,” she said.
This financial health status has enabled the Scheme to achieve the following:
- According to the independent Health Quality Assessment HQA report, GEMS outperforms the industry on most chronic disease outcome measures, such as Diabetes, HIV, and Hypertension.
- GEMS has the largest HIV Disease Management Programme among medical schemes, with more than 148,037 active participants receiving R2.3 billion worth of care per annum.
- The Scheme has adopted the UNAIDS 90-90-90 targets to ultimately end the AIDS epidemic. By 2022, the Scheme’s figures were as follows:
- 91% of all people living with HIV know their HIV status. 90.17% of all people with diagnosed HIV infection received sustained antiretroviral therapy.
- 20% of all people receiving antiretroviral therapy have viral suppression.
- GEMS was able to cover the unpredictable COVID-19-related costs for its beneficiaries in full during, and beyond the pandemic.
- In this regard, GEMS spent a total of R710.2 million towards COVID-19 costs in 2022.
- This made up 1.6% of all claims paid in 2022 and conducted approximately 1 477 607 in COVID testing, with 307 508 beneficiaries testing positive. Sadly, the scheme had 11 629 fatalities as of 31 December 2022.
