• Who is a subsidised patient?
• Subsidised patient fees

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
• is not a foreigner
• has an income less than R72,000 (single) R100,00 (family) per year.

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
partial subsidisation H1	>	less than R36,000 single income or R50,000 family income per year
partial subsidisation H2	>	from R36,000 to R72,000 single income or R50,000 to R100,000 family income per year
no subsidisation H3	>	more than R72,000 single income or R100,00 family income per year

You can download the UPFS Fee Schedule for subsidised patients.The subsidised fees are not divided into professional or facility fee components (as they are with full-paying patients) but instead an all-inclusive fee is charged. However, the fee still depends on the level of hospital and the type of professional providing the service, as it does with full-paying patients.

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 R1080 in a level 3 hospital, while a category D procedure in the same hospital has a facility fee of R7195.

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.

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 people are categorised as H0:

• social pensioners who receive the following grants:
  • old age
  • child support
  • veteran's
  • care dependency
  • pension for the blind
  • family allowance
  • maintenance grant
  • disability grant
  • single care grant (for persons with mental disorders in need of care, discharged from hospitals for the mentally ill, but not decertified)
  
  
  
• the formally unemployed, which means persons supported by the Unemployment Insurance Fund (UIF) who can produce their UIF Contributor's Record Card (UF74).

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 most services free of charge, the following are not free of charge for H0 patients:

• ambulance services and transport (but transport between hospitals is free)
• 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.

In exceptional cases, if the patient cannot make any payments, a patient may be re-classified to H0 even though they would normally have a different classification.

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. At the moment only people with an income of less than R36,000 per year for a single person and R50,000 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 of 1 April 2007.

Remember you will need to refer to the Code Books to find out the letter 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, which means they are not divided into the facility fee and professional fee. Where H1 patients receive a treatment which is listed as "free" on the schedule, at the very least a consultation or inpatient fee will be charged.

The fee for a bed in a ward (inpatient 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. So, for example, at Tygerberg (a level 3 hospital) the fee for the bed is R60 if you spend one day, and it is also R60 if you spend R30 days in hospital.

At the moment people with an income of more than 36,000 but less than R72,000 per year for a single person and more than R50,000 but less than R100,000 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. So, for example, at Tygerberg (a level 3 hospital) the fee for the intensive care bed is R145 if you spend 12 hours, and R290 if you spend more than 12 hours but less than 25 hours. If you move from one type of ward to another during a12 hour period, the higher fee applies.

Patients with an income greater than R72,000 per year for a single person and R100,000 per year for a family unit fall into this category. They are charged for services listed in the UPFS hospital tariff at full price and in the same way as other full-paying patients.