1. Introduction

(1)The Gauteng Department of Health has developed the following patient referral guidelines to

manage the increase of foreign citizens accessing public hospitals for medical treatment.

These guidelines apply to the following Non-South African citizens;

a. Foreign Patients who comes to South Africa specifically for Healthcare (Health / Medical

tourists),

b. Tourists who fell ill whilst visiting South Africa

c. Refugees/ Asylum seeker

d. Formally referred patients from another government/country

Without a structured process the Hospitals are subjected to an increase in unplanned patient

utilisation, poor budget planning and loss of revenue.

(2) The guiding documents for the development of these guidelines are:

a. Immigration Act no.13 of 2002

b. National Health Act no 61 of 2003

c. Refugees Act no 130 of 1998

d. Refugees Amendment Act no 12 of 2011

e. Refugees Amendment Act no 33 of 2008

f. Treaty of the Southern African Development Community of 1992

g. Uniform Patient Fee Schedule 2011

h. SADEC Protocol on Health

2. Purpose

To ensure that the Gauteng Department of Health comply with its mandate to provide healthcare,

ensure appropriate access, evaluate funds available and promote a cost-effective outcome.

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3. PATIENT CLASSIFICATION AND TARIFF DETERMINATION POLICY

Please note: The Uniform Patient Fee Schedule and tariff regulations are governed by the

national policy, which all Hospital must adhere.

(1) A foreign patient is defined as Non-South-African citizen who:

a. Visits the country specifically for medical treatment and whose visa is

endorsed “Medical Treatment”;

b. Is a Tourist who is referred to an OPD clinic by a private practitioner, (General Practitioner,

Specialist etc);

c. Is a Tourist and falls ill whilst in the country (Emergency cases);

d. Is a Tourist who receives emergency medical treatment at a public hospital, and after

discharge may require continued treatment, either as an in- or out-patient;

e. Has not yet attained South African citizenship status, such as a refugee / asylum

Seeker;

f. Is referred from another Government for the sole purpose of Health care

(2) Hospital officials should obtain full payment in advance in local currency before the foreign

patient is treated.

This excludes certain categories of foreign patients who are charged according to means test

similar to South African citizens who are not members or dependants of a medical scheme (Health

Insurance) who are the following:

a. Immigrants permanently residents in the RSA but have not attained citizenship

b. Those with temporary residence or work /study permits

c. Refugees/ Asylum Seeker (with asylum seekers permit or visitor’s permit). Refugee Act No 130

of 1998

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NB: Patients without permits must pay in full before treatment

(3) Foreign Patients without any documentation or permits shall not be refused emergency

medical treatment as outlined on the National Health Act No.61 of 2004. For non emergency

treatment, documentation and payment should be provided.

(4) According to the Immigration Act No 13 of 2002, section 44, 45 ‘ where possible any

Organ of State shall endeavour to ascertain the status or citizenship of the person receiving

its services and shall report to the Department of Home Affairs any illegal foreigner or any

person whose status or citizenship could not be ascertained.

(5) Hospitals should ensure that all documentations are valid and adhere to all relevant Acts

and Prescripts.

4. PATIENTS WHO ARE OFFICIALLY REFERRED FROM ANOTHER GOVERNMENT

(1) The admission of patients from outside the Republic of South Africa has to comply with protocols

as specified by the department of Home Affairs.

(2) The referring doctor must have made prior arrangements with the Chief Executive Officer of the

Hospital and receiving doctor, and the patient will be received as an “elective booked admission”;

(3) All patients referred to the appropriate public hospital must have a referral letter from their relevant

attending practitioner, with all relevant blood tests results, x-rays etc;

(4) The patient must arrive on the date of the appointment

(5) The patient reports to the OPD Medical Superintendent who completes and signs the letter of

authority (see attached GPF 6 and 7 forms: AUTHORITY TO ADMIT FOREIGN PATIENT TO

OUTPATIENT CLINIC), giving permission for the patient to attend for one clinic visit only.

(6) The completed authority form must accompany the patient to the Reception point and pays the

OPD visit tariff plus services before being allowed to attend the clinic. If the patient claims to have

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paid, proof of payment must be produced. All hospitals must verify proof of payment at the

designated payment office.

(7) If the patient needs any medication, a prescription will be issued to purchase from a private

pharmacy.

(8) Any follow-up clinic visits, treatment or in-patient admission must be assessed and listed, sent to

the Case Manager for costing, be authorised again by the OPD Medical Superintendent, and be paid

for in advance.

(9) If any follow-up treatment is necessary at the respective hospital, after the patient has been

discharged, authority must be obtained from the relevant Medical Superintendent in the prescribed

manner and the required payment be paid in the local currency before any further treatment is

initiated.

5. TARIFF DETEMINATION

(1) Foreign patients who visit the RSA exclusively for medical treatment are charged the full UPFS

prescribed private tariffs and must produce a cash payment in rands or a bank guaranteed cheque,

covering the total estimated costs. Should the cost of the service rendered be less than the estimated

cost, refund policy shall apply. If the cost of service is more than the estimated amount, the patient is

liable to pay the difference.

(2) A charge sheet (Addendum 1 of circular no. 81 of 2007) should be used to record all services to

be rendered and sent to billing for cost estimation.

(3) Non-South African citizens are eligible to free basic healthcare at Primary Health Care (PHC’ s

and Community Healthcare Centres (CHC’s) and this include patients who are pregnant, or children

under the age of six; or patients coming for termination of pregnancy (TOP), performed for medical

reasons, other than complications of the TOP.

(4) Patients who are members or dependants of a Foreign Medical Scheme are liable for the full

UPFS tariff and should pay all fees in Cash in the local currency before services are rendered.

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6.DISCHARGE PROCEDURE

(1) Pre-discharge procedure: The attending doctor in charge of the patient, case manager or

ward clerk informs the billing department well in advance of when the patient is to be

discharged so that the billing department can finalize the account before the patient is

discharged. No refunds will be paid out until the relevant doctor informs the relevant

department that all treatment has been completed and no future follow-up appointments are

required.

(2) Any discharge medicines are costed and included in the account (maximum of 24-hours

medicine) unless specifically authorised by the Medical Superintendent after discussion with

the Chief Pharmacist.

Hospitals should ensure that the GPF 6 form is completed for all Foreign Patients and sent to

statistics department for record purposes.

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DRAFT GUIDELINES FOR ADMISSION AND TREATMENT OF FOREIGN PATIENTS IN PUBLIC HEALTH INSTITUTIONS

GPF 6

Dear .........................................................

re : ...........................................................

Professor ..……………............................, Head of Department of .......................

…………....., has informed me that you have been referred to PROVINCIAL Hospital

for treatment.

Please be advised that should you be accepted for treatment, you must provide a

bank-guaranteed cheque or pay cash to the value of R....................... (amount in

words:

)

before admission in order to cover your hospital expenses (see copy of Annexure A).

The above amount is an estimated cost for services and treatment. If the cost of

treatment is more than the amount estimated, you will be liable for the difference on

discharge.

Should the cost of treatment be less than that stated above, you will be refunded the

difference once treatment, including follow-up visits, is completed in full.

Yours sincerely

__________________________________

MEDICAL SUPERINTENDENT

PROVINCIAL HOSPITAL

c.c. Professor (Head of Department)

Fees office

Main Admissions

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GPF 7

PROVINCIAL HOSPITAL : FOREIGN PATIENT ADMISSION

PATIENT:………………………..ADMISSION DATE:……………………FIL.NO:……………….

COMPLETE EITHER PART A : ELECTIVE ADMISSION OR PART B : EMERGENCY

ADMISSION

A. ELECTIVE ADMISSION

1. Amount paid in advance

Authority granted for admission

(A) (B) (C)

TOURIST VISITING SOUTH AFRICA FOR MEDICAL

TREATMENT

(ATTACH COPY OF VISA, IF AVAILABLE)

FOREIGN AFFAIRS CASE: Refugee/ Asylum seeker

(ATTACH PROOF)

ADMISSION CLERK: ………………………………………………………(Sign and print name)

2. Estimated cost of treatment Admission Approved

If a patient in Category “B” above is to be admitted without full advance payment, kindly

state reasons below:

……………………………………………………………………………………………………

……………………………………………………………………………………………………

……………………………………………………………………………………………………

……………………………………………. ……………………………

SUPERVISOR(Sign and print name) DATE

NIL R

YES NO Medical/Superintendent:

R YES NO

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B. EMERGENCY ADMISSION

I have assessed the patient and deem it necessary for admission

………………………………………….. …………………………..

CONSULTANT DATE

After Hours : I, the Registrar, have discussed this case with the Consultant on call, and

have obtained permission for admission from the Medical Superintendent on call.

………………………………………….. …………………………..

REGISTRAR DATE

(For Medical Superintendent on call)

............................................................................

MEDICAL SUPERINTENDENT

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