The Gauteng department of health says the Road Accident Fund (RAF) owes it R1.6bn for treating crash victims in the province’s hospitals, and the institution is one of the many debtors contributing to its crippling R4.6bn debt.
Of this sum, R2.4bn in outstanding fees is from self-paying patients, including citizens and foreigners, it said.
“A significant portion of this category is attributable to foreign nationals, though the debt is not exclusively owed by them, as South African self-paying patients also contribute to this figure. The remaining balance consists of intergovernmental debt and outstanding payments from medical schemes,” said the department.
Regarding the RAF and its outstanding payments, the department said when a motor vehicle case is seen in a hospital or any health facility, the hospitals are expected to claim for the healthcare services rendered to the patient.
“RAF is an entity that receives funding or a levy of which part of its component is payment of medical claims as a result of liability or service rendered. So, we billed for these services, and RAF didn’t pay. These are historical claims.”
It said there was money owing from the department of justice and correctional services, the South African Police Service (SAPS), the Compensation Fund and the North West province.
- RAF: R1.6bn;
- Department of justice: R94m;
- SAPS: R36m;
- Correctional services: R53m;
- Compensation Fund: R17m; and
- North West province: R22m.
“These accounts are traceable and legally enforceable, and structured recovery processes are under way to recover these funds,” said the department.
According to the department, public healthcare services are not entirely free.
“The system operates under the Uniform Patient Fee Schedule (UPFS), which provides a structured, income-based framework for billing services. While primary healthcare services are free, hospital-based services are subsidised depending on a patient’s classification.
“Debt arises when patients who are liable for payment do not settle their accounts, when medical schemes delay or dispute payments, and in cases where patients are untraceable. In emergency and high-risk cases, treatment is provided without delay, regardless of a patient’s ability to pay,” it said.
This comes after last year’s 4.4% general patient fee increase by the department, which included a 30% hike in emergency medical services (EMS) standby fees.
The province is now proposing another round of tariff adjustments for 2026/27 under the UPFS, with the gazette out for public comment.
With regards to self-paying patient fees, the department said most of the debt comes from maternity services.
“Outstanding debt is generally concentrated in high-volume regional and tertiary hospitals, where demand for specialised and emergency care is highest. Maternity services are a significant contributor, driven by high patient volumes, emergency presentations and cases where patients may not be traceable after receiving care.”
The department reiterated that no patient is denied access due to outstanding debt. “However, patients who are liable for payment continue to be billed for services rendered, and measures such as upfront payment protocols, improved patient classification and strengthened verification systems are being implemented to support cost recovery
“While primary health care is free, hospital services are not. The existence of outstanding debt reflects both the scale of demand on the public health system and the complexity of recovering costs, particularly in cases involving untraceable patients,” it said.
Sowetan
Koena Mashale
www.timeslive.co.za
