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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 visitors 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 (CHCs) 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)
TOURIST

NIL

YES

NO

Medical/Superintendent:

(B)

(C)

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

YES

NO

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

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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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