BACKGROUND:
The rising non-communicable disease(NCD) burden, growing multimorbidity, and increasing utilization and hospital costs highlight an unsustainable, reactive system. Expanding equitable preventive care is crucial to slowing disease progression, reducing costs, and supporting South Africa’s universal health coverage (UHC) goals. Within the Government Employees Medical Scheme (GEMS), it remains unclear whether preventive benefits reach high-risk groups or affect disease progression. This study examined long-term trends in NCD burden, multimorbidity, service utilisation, expenditure, and preventive care uptake to guide value-based strategies for NCD management.

METHODS:
A retrospective cohort study analyzed anonymized GEMS claims data from 2019 to 2024 (over 5 million member-years). Beneficiaries with complete demographic records and at least one annual claim were included. Harmonised variables covered diagnoses, utilisation, preventive services, multimorbidity, and expenditure. Descriptive statistics quantified disease burden and costs, while multivariate regression identified predictors of preventive care uptake. Longitudinal associations and equity analyses were conducted in STATA and R.

RESULTS:
Major NCDs increased throughout the study period, with rises in diabetes, cancers, and asthma, while hypertension remained the most common. Multi-chronicity grew alongside service utilisation: General Practitioner visits rose from 5.9 to 7.4 million, specialist encounters from 1.17 to 1.37 million, and allied services nearly doubled. Hospital admissions increased by 23%, accompanied by a steep rise in costs, including an 84% increase in hospital expenditure. Preventative care uptake stayed below 35%, mainly among females, urban residents, and higher-income groups. Those using preventative services had lower annual costs and hospitalisation, showing clear benefits for cost and risk reduction.

CONCLUSIONS:
The rising NCD burden, increasing multimorbidity, and escalating utilisation and hospital costs signal a reactive and unsustainable care model. Expanding equitable access to preventive services is crucial for slowing disease progression and containing costs. Targeted, value-based prevention strategies are critical for enhancing outcomes and advancing South Africa’s UHC goals.