SOLVENCY RATIO CONCERNS
Unified medical scheme plan for public servants hits first big roadblock
The Council for Medical Schemes has hit its first stumbling block over its proposed consolidation of all the medical schemes for public servants with the Government Employees Medical Scheme (Gems), after the Public Servants Association (PSA) said it had "serious reservations" about the plan.
The measure is contained in a discussion document published by the council last week, and is in line with the government’s white paper on National Health Insurance (NHI).
The PSA’s 242,000 members make up about a fifth of the public service.
It said on Tuesday that Gems did not have the capacity to absorb more beneficiaries.
"Gems needs to be cleaned up first," said PSA spokesperson Tahir Maepa.
The PSA has received numerous complaints about Gems, its solvency ratio was below the statutory requirement of 25% and it did not have the capacity to deal with rampant fraud, he said.
Gems has about 1.8 million members and provides cover to more than half of all eligible public servants.
It made headlines in August 2016 when its solvency ratio plummeted on an unexpected surge in costly hospital admissions: from 9.46% in December 2015 to an intrayear low of just under 4% in September, before recovering slightly to end the year at 6.99%.
It has since improved, and ended 2017 on 15.22%, but still does not meet the requirements of the Medical Schemes Act.
Maepa said consolidating all the medical schemes for public servants with Gems would reduce competition and diminish members’ influence.
"The problem is that Gems is becoming a monopoly. The moment [it] becomes [the only] medical aid for public servants, Gems will do as it wishes," Maepa said.
Gems was created through a collective agreement at the Public Service Co-ordinating Bargaining Council and any proposed merger would have to be discussed there, said Maepa.
Gems principal officer Guni Goolab said: "We are cognisant that changes of this magnitude will only be implemented after extensive stakeholder engagement and consultation led by government." He said it had embarked on several interventions to mitigate the challenges identified by members.