Q AND A WITH DEPARTMENT OF HEALTH REGARDING DEBTS OWED BY PATIENTS

By Gauteng Department of Health

1.How many undocumented foreigners owe the Department money regarding health care and how many South Africans owe the Department money regarding health care that was offered to them?

A. The Department can’t give an exact count of undocumented foreign nationals who owe money, person by person due to old administrative problems that made it hard to collect patient information across facilities.

For a long time, hospitals had to put emergency care first, and they were often criticized for having strict rules about who could be treated.

Because of this, foreign nationals often came in with:

•different ways to spell their names,

•different ways to spell it on different visits,

•names that were different at different facilities,

•or no formal ID at all.

This means that the same person could show up in the system more than once.

As a result, any attempt to get an exact count would be wrong and misleading and the Department will not give out numbers that can’t be checked.

2.What we can say for sure is that, based on how things are used and how they are billed:

A. Based on service-level data, 60% or more of the self-paying debt is due to foreign nationals, especially in maternity and emergency units.

•There are about 000 – 000 foreign-national accounts connected to this debt, but this number includes duplicate and inconsistent entries because of the problems mentioned above.

•There are about 000 – 000 South African accounts linked to self-paying debt, where identity information is usually more consistent and easier to find.

Because the old system didn’t enforce identity verification, it’s important to stress that these are account-level estimates, not verified individual counts.

This is exactly why the Department is now putting in place consolidated KYC,biometric verification, and digital patient-identity systems.

These changes will make sure that:

•every patient has one unique identity in the system,

•patients who come back can be linked to past debt, and

The Department will now be able to give correct, verifiable numbers both at individual and account levels.

3.What kind of patients qualify for free health treatment and what kind of patients don’t qualify for free health treatment?

A. Eligibility for free or subsidised care is determined by the Uniform Patient Fee Schedule (UPFS), which is a national policy framework applied across all provinces.

Patients who qualify for free care include:

•Those receiving primary healthcare services at clinics.

Certain categories such as: Pregnant women for defined maternal services,

Children under a specified age,

Patients with specific conditions covered under national policy,

Social grant recipients in certain categories.

Patients who do not qualify for free care include:

•Individuals in higher income categories (H1, H2, H3), based on means testing.

•Medical scheme members.

•Patients whose care is funded by third parties such as RAF or COIDA.

•Non-subsidised foreign nationals, who are billed according to UPFS tariffs.

The UPFS ensures that vulnerable groups are protected, while those who are able to contribute do so in line with national policy.

4.What concrete or practical steps is the Department going to take in order to trace undocumented patients so as to get them to pay what they owe?

A. The Department has been clear that it is very hard to get back old debts from undocumented patients because the system didn’t require strong identification at the point of care before.

The goal now is to stop the problem from getting worse by:

Deploying new KYC systems (incl biometric verification and HA integration) where will register every patient using: Numbers for ID,

Information about your passport,

Or unique biometric identifiers.

This makes sure that a patient who comes back is automatically linked to their past record, including any debts they still owe.

•Better screening of income meaning that:

•Patients will be correctly put into UPFS, which will make sure that billing is correct from the start.

•Digital debt warning

•The system will flag any unpaid amounts and set up payment plans for patients who are eligible to pay before they get any more non-emergency services.

•Keeping emergency care safe

•As the law says, emergency and life-saving care will always be given.

•The Department will now make sure that debt that doesn’t need to happen doesn’t build up.

The goal is to bring the system up to date, make sure people are held responsible, and stop the problems from the past that made it impossible to trace.

5.Why does the Department of Health keep on providing health care to undocumented foreigners even though it has become clear from your statement that it is impossible to trace such people in order to get them?

A. The country’s Constitution and national health legislation require that no person in a life-threatening or emergency condition may be denied care, regardless of nationality or documentation status.

This applies to South Africans and foreign nationals.

The Department therefore provides emergency and essential care because:

•It is a legal obligation,

•It is an ethical obligation, and

•It is a public health necessity, as untreated emergencies can create broader risks for communities.

At the same time, the Department has been clear that the current situation is not sustainable, which is why:

•New KYC and biometric systems are being introduced,

•Income screening is being strengthened,

•And non-essential services for patients with outstanding debt will be managed differently going forward.

Our approach as the GDoH is to strike a balance between constitutional obligations and responsible financial management, while working with national government on long-term structural solutions.