Socioeconomic determinants of mental health service utilisation: A retrospective analysis of Government Employees Medical Scheme (GEMS) claims data (2019 - 2024)
1
Research and Development, Government Employees Medical Scheme, Pretoria, South Africa
2
Government Employees Medical Scheme, Pretoria, South Africa
3
Healthcare Management, Government Employees Medical Scheme, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Mental health disparities are broadening across South Africa, yet there is limited evidence on how socioeconomic determinants of health (SDOH) affect both mental health outcomes and the use of related benefits and services among insured populations. This study assesses the impact of income, education, age, gender, geography, and chronic disease burden on mental health service utilization among members of the Government Employees Medical Scheme (GEMS) between 2019 and 2024.
METHODS:
A retrospective cohort analysis was conducted using GEMS administrative and claims data from 2019 – 2024. Variables included sociodemographic characteristics, mental health–related service utilisation, benefit option, and chronic condition profiles. Descriptive statistics, standardized comparisons, and multivariate logistic regression were employed to analyze associations between SDOH and mental health service utilization.
RESULTS:
Mental health service utilization increased significantly over the six-year period, with notable disparities across various groups. Women, particularly those aged 60 and above, were the highest users (59%), and urban members accessed care more frequently than rural members (52% versus 42%). Utilization was also substantially higher among people with ≥2 chronic conditions and among lower-income beneficiaries, especially those on the Tanzanite One plan. Membership grew by 27% during the period, with a greater number of younger and lower-income members joining. Regression analysis showed that being female, older, lower income, living with multimorbidity, and residing in urban areas were key predictors of higher mental health service use.
CONCLUSIONS:
Clear socioeconomic and demographic gradients underpin mental health service utilisation within GEMS. These inequities emphasise the need for targeted interventions aimed at high-risk groups and the expansion of community-based, preventive mental health models. Addressing upstream structural determinants will be essential for achieving equitable and sustainable mental health outcomes.
Mental health disparities are broadening across South Africa, yet there is limited evidence on how socioeconomic determinants of health (SDOH) affect both mental health outcomes and the use of related benefits and services among insured populations. This study assesses the impact of income, education, age, gender, geography, and chronic disease burden on mental health service utilization among members of the Government Employees Medical Scheme (GEMS) between 2019 and 2024.
METHODS:
A retrospective cohort analysis was conducted using GEMS administrative and claims data from 2019 – 2024. Variables included sociodemographic characteristics, mental health–related service utilisation, benefit option, and chronic condition profiles. Descriptive statistics, standardized comparisons, and multivariate logistic regression were employed to analyze associations between SDOH and mental health service utilization.
RESULTS:
Mental health service utilization increased significantly over the six-year period, with notable disparities across various groups. Women, particularly those aged 60 and above, were the highest users (59%), and urban members accessed care more frequently than rural members (52% versus 42%). Utilization was also substantially higher among people with ≥2 chronic conditions and among lower-income beneficiaries, especially those on the Tanzanite One plan. Membership grew by 27% during the period, with a greater number of younger and lower-income members joining. Regression analysis showed that being female, older, lower income, living with multimorbidity, and residing in urban areas were key predictors of higher mental health service use.
CONCLUSIONS:
Clear socioeconomic and demographic gradients underpin mental health service utilisation within GEMS. These inequities emphasise the need for targeted interventions aimed at high-risk groups and the expansion of community-based, preventive mental health models. Addressing upstream structural determinants will be essential for achieving equitable and sustainable mental health outcomes.
| eISSN: | 2654-1459 |
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