Subsidised patients are any patients who are not classified as full-paying patients. They are categorised according to their ability to pay for health services. In practice, this means that a subsidised patient:
- Is not externally funded, which means that no other fund or entity is required by law to pay their fees.
Patients are classified as single or family units for the purposes of placing them in income categories. A family unit includes a couple, a single parent, or a single person with a dependant. A widow or widower without dependants is a single unit rather than a family unit.
There are four income categories of patients:
- Full subsidisation H0 >Pensioners and the unemployed.
|>||Less than R70 000 single income or R100 000 family income per year.|
|>||From R70 000 to R100 000 single income or R250 000 to R350 000 family income per year.|
||>||More than R250 000 single income or R350 000 family income per year.|
The UPFS Billing Procedure Schedules refer to categories of medical procedure in some instances, for example, for theatre procedures. Every medical procedure is assigned a cost code, A, B, C, D, or E which is a cost code, from A (least expensive) to E (most expensive).
So to find the fee for a particular procedure, you have to know what the cost code is for that procedure. The lists of all the procedures with their cost letter codes are in the Procedures Code Book, Oral Health Code Book. Radiology Code Book, Cosmetic Surgery Code Book and Nuclear Medicine Code Book.
Patients in this group receive most services free of charge. Patients must provide documentary evidence that they fall into this category. The default classification for someone without an income is H1, not H0. The following patients are categorised as H0:
- Social pensioners who receive the following grants:
- Old age.
- Child support.
- Care dependency.
- Disability grant.
- Foster care.
- The formally unemployed, which means persons supported by the Unemployment Insurance Fund (UIF) who can produce a formal document issued by the Department of Labour.
Patients who would normally be H0 patients but who are externally funded for certain treatment, are classified as full-paying, as are patients being treated by a private doctor in a government hospital.
Although patients classified as H0 get various services free of charge, the following are not free of charge for H0 patients:
- Issuing medical reports and X-ray copies, and completion of certificates and forms.
- Cosmetic surgery.
- Contested fatherhood tests (paternity tests).
- Immunisation for foreign travel.
The charges for these items are set out in the UPFS Fee Schedule for subsidised patients.
This is the default group for subsidised patients, which means you are classified as H1 unless there is information available which puts you in another category. Currently, only people with an income of less than R70 000 per year for a single person and R100 000 per year for a family unit fall in this category.
How much an H1 patient has to pay for different kinds of treatment is set out in the UPFS Fee Schedule for subsidised patients.
Remember you will need to refer to the Code Books to find the cost code (A, B, C, D) for medical procedures, as the schedule refers to these codes in setting the fees.
The H1 patient tariffs listed in UPFS Fee Schedule for subsidised patients are all inclusive. An all inclusive fee means that additional services such as X-ray are included in the in-patient or consultation fee with certain exceptions such as Dental Laboratory Items. The aforementioned is indicated on the UPFS Fee Schedule.
The fee for a bed in a ward (in-patient fee) is for every 30 days or part thereof. This means that the fee is the same if you spend 30 days in hospital or less than 30 days.
Currently people with an income of more than R70 000 but less than R250 000 per year for a single person and more than R100 000 but less than R350 000 per year for a family unit fall in this category.
For H2 patients, the fee for a bed in a ward (inpatient fee) is for every 12 hours or part thereof. The tariffs for H2 patients are set out in the UPFS Tariff Schedule for subsidised patients. If you move from one ward type to another eg a general to a high care ward during a 12-hour period, the higher fee applies ie high care ward fees.
Patients with an income greater than R250 000 per year for a single person and R350 000 per year for a family unit fall into this category. They are charged for services listed in the UPFS Fee Schedule. Patients in this category are partially subsidised with certain exceptions.
NB: For enquiries please contact the relevant hospital (head of fees/case manager).