Care Expert programme benefits GEMS knee replacement patients

GEMS (Government Employees Medical Scheme) members who need knee replacement surgery at Mediclinic Midstream can now use the Care Expert programme. 

This change allows participating orthopaedic surgeons to help even more patients.

Efficient care, financial certainty

The Care Expert Knee Arthroplasty Global fee model is a surgical inclusive model that includes the hospital component, prosthesis and orthopaedics surgeon’s fee (in addition to the assistant’s fee).

Mediclinic is pleased to partner with GEMS in introducing this model across all of the GEMS’ options with a strong focus on patient outcomes and clinical performance through the support of a specialist navigator who assists in driving a seamless experience for members. This model seeks to improve quality care through targeted, measured outcomes. Mediclinic looks forward to introducing more high value products to the scheme in the new year.

Optimising patient care

With South Africa’s population ageing, and many on GEMS, demand for joint replacement surgery is growing, says  Dr Beyers Oosthuizen, an orthopaedic surgeon at Mediclinic Midstream. “GEMS is one of the biggest medical funders in the country, so a huge population group now has access to knee replacements.”

Care Expert not only eases financial worries but also supports better patient care by streamlining treatment and recovery. Surgeons can operate more efficiently, making procedures both cost-effective and clinically more effective for eligible patients who are under contracted funders.

“Over the past couple of years, research has clearly shown that rapid recovery in joint replacement surgery is beneficial to patients,” Dr Oosthuizen confirms. “Patients rehabilitate faster and the pain control is better. They also have lower risk of infection, comorbidities, and pneumonia. The faster you can get the patient moving and discharged, the faster and better their postoperative recovery and mobility is. That aligns with the model of a global fee, because both the patient and the funder benefit – it’s a synergistic relationship.”

But that doesn’t mean treatment should be rushed, he emphasises. This doesn’t benefit patients or funders, who will likely have to cover readmission. “The idea is to be effective and not waste time or resources. It’s about finding a balance – being cost-effective in a way that benefits the patient, especially those with comorbidities, while also supporting the funder. It encourages everyone involved to provide better, more professional, and efficient care.”

Restoring quality of life

Barend Marais, a 64-year-old educator who also works with the Bulls rugby team, needed two total knee replacements due to ongoing wear and tear. His second surgery, performed by Dr Oosthuizen at Mediclinic Midstream in August 2025, was made much easier financially through the Care Expert programme. “It helped me a lot, as I had far lower costs than I would have otherwise,” he says. “Without it, I would have had to make additional payments.”

Prior to his knee surgeries, Marais says he was in pain 24 hours a day for a year and a half. “I was coaching rugby overseas, so I delayed having the operations. But I couldn't walk any longer like that; I’d have to stop and stretch after 20 metres. I couldn’t do anything anymore, it was terrible.”

Marais says the service at Mediclinic Midstream was excellent. “Before, I didn’t have any quality of life, only pain. Now, I have my life back, I'm walking about 5km daily and I can do exercises that I thought wouldn’t be possible again. If it weren’t for the operations, I’d still be in the same situation.”