Ironies prevail in ‘low cost’ private health cover, ‘uncovered’ utilisation
The medical schemes regulator appears reluctant to allow private medical schemes to enter the primary healthcare space in the form of low-cost...
Imagine how interesting it would be for the commercial health insurance sector if South Africa’s second-largest medical scheme, the Government Employers Medical Scheme (GEMS), the closed scheme for public servants, had to open its doors to members of the public right now – the crux of a question posed “from the floor” to GEMS principal officer, Dr Stan Moloabi, during last Friday’s IHRM-hosted webinar on what medical schemes are doing to measure outcomes.
Moloabi and delegates were reminded by the questioner that in the original GEMS design before its 2005 launch, the intention was for it to become an open scheme for the public. Recent indicators show that GEMS now has close to a million main members with more than two million beneficiaries.
In his immediate response, Moloabi noted that it was interesting that the question had been asked on the day it was announced by the Portfolio Committee on Health that the NHI Bill had reached its final stages: “Today Parliament is looking at the NHI Bill and whatever the outcome, there is going to be a process that is going to influence policy direction in terms of how healthcare will be funded. Whatever we are doing as schemes at the moment, we are doing in terms of Medical Schemes Act regulations.
“Now, to answer your question, I have to explain why GEMS exists. It does so as a result of a mandate from our employer, the government, which employs public servants. As a result, GEMS is a closed scheme for public service employees.
“I am often asked the question, will it ever become an open scheme? Truth is,” Moloabi explained, “we operate in a regulatory environment so we have a mandate driven as a closed medical scheme – a closed medical scheme for the government as is the case with other closed medical schemes covering both public and private entities in terms of the Medical Schemes Act.
“I think it would be a good thing if could happen but it is a closed scheme as we speak.”