Perspective Chapter: Financing Private Healthcare for Government Employees to Improve Access

Abstract

Eight years following the first democratically elected government in South Africa in 1994, most public sector employees remained unable to access private health insurance and care due to high cost. In 2002, the Parliamentary Cabinet approved a policy framework on a restricted medical insurance scheme for public sector employees. This policy centered around the principles of equity, efficiency, and differentiation. Employees would have access to essential healthcare benefits across different option plans under equitable remuneration structures based on their health needs. The establishment of the Government Employees Medical Scheme (GEMS) was approved by the Cabinet in 2004 and was then registered and operationalised in January 2005. This chapter aims to describe the evolution of GEMS as the largest closed medical insurance scheme within South Africa over the past 18 years, and how it improved access to care by embracing Universal Health Coverage (UHC) principles. We present the socio-demographic evolution of the Scheme and how it and the employer have provided affordable contributions and expanded healthcare benefits to universally cover members, their immediate and extended families during their active working years and retirement. We also expand on member-centric benefit design and the critical role of organised labor and government, as both employer and policy maker.