Johannesburg - Government is forcing a major re-orientation of the R35bn-a-year medical aid sector through its own medical scheme, the Government Employees' Medical Scheme (Gems).
The shake-up is seen in some quarters as likely to result in the lowering of the cost of private healthcare in the country.
Detractors claim a dominant Gems, expected to grow to cover over 1 million principal members within a couple of years, is not good for the medical aid market.
Gems opened for business more than a year ago and has already signed up 130 000 main members, many of whom have been drawn from some of the more established open schemes.
Government has 500 000 of its employees as members of 15 open schemes and has stated its intention to lure them into Gems, a move which, if successful, will result in a radical alteration of the open medical aid market.
Dangling carrots
It has dangled a carrot before these public servants to entice them to cross over. Workers on Gems get a better subsidy and all those earning R60 000 or less a year have essentially been offered free cover.
Hundreds are switching to Gems daily, forcing schemes to find creative ways to remain viable and in business. The affected schemes' administrators are also feeling the pinch and have had to re-look their business models.
Bonitas, one of the oldest schemes in the market with by far the biggest exposure to the public sector, has had to look elsewhere for business.
It has adopted an aggressive marketing campaign, which has included sponsoring two Premier Soccer League outfits - Jomo Cosmos and the just-promoted Free State Stars - and associating with the Comrades Marathon.
Diversifying into financial services
Medscheme, the country's premier multi-scheme manager, which looks after Bonitas, FedHealth and Liberty, has launched a concerted campaign to grow its financial services market out of a realisation of the challenges brought about by Gems and a largely stagnant business.
Medscheme chief executive Andre Meyer said the company would harness its health and financial risk management expertise to offer a unique and highly competitive range of financial services products, including life cover and short-term insurance.
"We have to diversify. The healthcare business is heavily regulated and has had no real growth for years," he said.
Bonitas has the highest public sector exposure of the schemes administered by Medscheme.
"We believe consolidation is going to come, public servants will move to Gems and since studies have shown that public servants have a better claiming profile, Gems will be competitive and offer good value for money."
Unfair advantage
Joe Kunniger, managing director of Status Medical Aid Administrators, which caters for nine schemes with a total of 35 000 principal members, said the industry regulator, the Council of Medical Schemes, has failed to level the playing field.
About 10% of the membership in the schemes managed by Status are civil servants.
Kunniger says the provision that allows government employees on Gems to get better benefits (larger subsidies) than those on other schemes is unfair and takes away individuals' right to freedom of choice.
"All new government employees have to join Gems and members are leaving schemes because of the discrimination in benefits that favour Gems," he said.
Government force
Government argues it was forced to come into the market by the inefficiencies in the private medical aid business where a large percentage of member contributions are spent on non-healthcare expenses.
Millions of rands are paid to brokers who do not bring in any new business that results in growth of the number of South Africans on medical aid, but to move members between schemes.
Gems was launched out of the need by government to have a say in how the R5bn a year it pays to medical schemes is expended and to extend cover to the rest of the public service.
More than 300 000 state employees in the lower income groups do not have medical aid cover.
Buti Sithole, the principal officer of Hosmed, one of the open schemes bleeding members to Gems, said his scheme had projected it would lose members to Gems at a rate of 3 000 a year.
Hosmed lost more than 4 000 members to Gems between February last year and March this year. Hosmed's total membership is 16 000.
Losers and winners
All 15 open schemes and a number of administrators are set to be adversely affected.
As much as there are losers, there are also winners.
The companies that have the contracts for the administration of Gems, have seen phenomenal growth in their business.
Medscheme's health risk solutions business won the tenders for managed care and HIV/Aids consulting services.
"We have seen phenomenal growth in this business through Gems. Just in the last month we have seen 15 000 new members come through," said Meyer.
Metropolitan Health Group, which administers the state medical aid scheme, will also be chuffed at the meteoric rise of Gems.