• Who is a full-paying patient?
• Full-paying patient fees

Full-paying patients:

• are externally funded OR
• private patients OR
• non-South Africans OR
• have an income of more than R72,000 (single) or R100,000 (family) per year.

Externally funded patients

These are patients whose hospital fees are funded through or being paid by:

• the Compensation for Occupational Injuries and Diseases Fund (formerly Workmen's Compensation Fund)
• the Road Accidents Fund
• medical aid schemes
• another state department
• a local authority
• a foreign government
• an employer.

Their treatment incurs the full UPFS fee.

Private patients

A private patient is a patient treated in a government institution by a private practitioner. These patients pay the full UPFS facility fee.

Non-South Africans

Patients are treated as South African if they are:

• South African citizens
• permanently resident in South Africa
• visitors or foreigners with study permits, temporary work permits or temporary visitors permits
• persons from neighbouring states.

Patients who do not fall into these categories, including foreign tourists, must pay the full-paying UPFS fee.

The Uniform Patient Fee Schedule (UPFS) is the tariff which sets out the fees which full-paying patients are charged at government hospitals in the Western Cape.

Fee Components

The UPFS Fee Schedule for full-paying paying patients has two components for the fee for each service:

• the facility fee
• the professional fee.

A patient, for example, who has an outpatient hospital consultation is charged, per visit, a professional fee plus a facility fee. The amount of the professional fee and the facility fee depends on the type of professional and the level of hospital providing the service.

The amount of the facility fee depends on the level of hospital. In our example of an outpatient consultation, the UPFS facility fee at a level 3 hospital is R55, while at a level 1 or level 2 hospital it is R46. For more on hospital classifications, click here.

The amount of the professional fee depends on the category of professional providing the service. In the example of an outpatient consultation, where a general medical practitioner provides the service, the professional fee is R51, but if a specialist medical practitioner provides the service it is R117. For more on classification of professionals, click here.

In our example, a full-paying patient who made one outpatient consultation visit to Tygerberg hospital where the service was provided by a general medical practitioner would be charged R55 (facility fee) + R51 (professional fee) = R106. Of course, this assumes no other service or medication was provided and is only the fee for the consultation.

Procedures Schedules

You can download the UPFS Billing Procedure Schedule for full-paying patients and the Schedule for orthotic aids.

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 letter code, A, B, C, or D, which is a cost code, from least (A) to most (D) expensive.

For example, a category A theatre procedure has a full-paying facility fee of R1182 in a level 3 hospital, while a category D procedure in the same hospital has a facility fee of R7882.

So to find out the fee for a particular procedure you have to first know what the letter code is for that procedure. The lists of all the procedures with their cost letter codes are in the Procedures Code Book and Oral Health Code Book.

The first column on the right in the Code Book lists the professional fee code while the second column is the facility fee code.

To give an example, according to the Procedures Code book a heart transplant is a category D (facility) theatre procedure, while a breast biopsy is a category A (facility) theatre procedure. This means the full-paying facility fee for a heart transplant is R7882 while for a breast biopsy it is R1182.