The  national health department has withdrawn its instruction to provinces to charge foreign patients the maximum rate, saying the directive should never have been issued.

Provincial health departments received a letter from the department in mid-January instructing them to ensure all non-South African patients pay the full rate for services. The only exception would be refugees with valid documents, who would get discounted fees if they had  low income.

Government hospitals and clinics charge patients according to the uniform patient fee schedule, which has different rates depending on a patient’s income, but makes no distinction between SA citizens and foreigners. Patients from the poorest households get free services, those on an annual household income of R70,000-R250,000 pay reduced fees, while those with an income of more than R250,000 pay in full.

The health department’s deputy director-general for National Health Insurance (NHI), Anban Pillay, said the letter sent to the provincial health departments was drawn up by a junior official who did not have the authority to introduce changes. It was rescinded on Saturday after the Western Cape provincial health department and journalists started asking questions, he said.

Western Cape health department spokesperson Marika Champion confirmed the circular was withdrawn.

The Western Cape had not implemented the new policy directive, she said. “We felt our systems were not ready, and asked for areas of policy clarification,” she said.

Gauteng’s health department appeared to be the only one that wrote to health-care facilities instructing them to charge all foreign nationals at the maximum rate for health services, including emergency care, said Pillay.

The national health department does not have figures for the number of foreign patients using government hospitals, but about a fifth of patients enrolled on its chronic-medicine service were non-South Africans, he said.

Pillay said the silence of current regulations for the schedule on nationality had created confusion about  rates foreigners should pay. The national health department was drafting regulations to clarify the situation and spell out that all patients using state health-care facilities should be charged according to a means test, regardless of their nationality, he said.

Gauteng health MEC Gwen Ramokgopa said the province aligned itself with national policies and withdrew its directive to public health facilities to charge foreigners the maximum rate.

“I would like to dispel the [myth] that the circular that was issued by the Gauteng health department said foreign patients will not be treated. It was saying, in line with the national circular that has now been withdrawn, that they would be billed fully for the expenses. It never said first get the money before you treat,” she said.

Ramokgopa said foreigners, just like South Africans, should be billed according to the means test in the schedule. 

“We understand the concern of foreigners who would not be able to afford the full cost of services,” she said.