__family_medicfffhrfggggggggghhyyyyyy.pdf

Mirriam Mogotsi- Family Medicine
and PHC 2014
Mirriam Mogotsi
Department for family medicine

 There is five levels of hospitals and this is
regulated by NATIONAL HEALTH ACT, 2003
(Act No.61 of 2003)
 POLICY ON THE MANAGEMENT OF PUBLIC
HOSPITALS
 http://www.doh.gov.za/docs/policy/2012/ho
spmanpolicy.pdf
Mirriam mogotsi- Family Medicine
and PHC 2014

One of the crucial aspects of this policy is to
ensure reclassification of hospitals to address
issues of:
 Equity
 Affordability
 Efficiency
 Effectiveness
Mirriam Mogotsi- Family
Medicine and PHC 2014

 Primary health care services are available free
of charge at State health care facilities:
◦ clinics;
◦ community health centres;
◦ mobile clinics;
◦ satellite clinics;
◦ health care facilities that are funded or subsidised
fully or partly by the State
and PHC 2014

These will be classified into 3 categories:
1. Small district hospitals with no less than 50
beds and no more than 150 beds;
2. Medium size district hospitals with more
than 150 beds and no more than 300
beds;
3. Large district hospitals with no less than 300
beds and no more than 600 beds.
and PHC 2014

 Management: A medically trained person to act
as both CEO and clinical manager.
 Services: It includes trauma and emergency care,
in-patient care, out-patient visits and paediatric
and obstetric care. The services are provided by
family physicians, general practitioners, and
clinical nurse practitioners (PHC).
**These hospitals may only employ specialists
in the form of family physicians, paediatricians,
obstetrician/gynaecologists, and general surgery.
and PHC 2014

 Services: At general specialist level, receive
referrals from district hospitals and provide
general specialist services to a number of
district hospitals.
 They also serve as a platform for training of
health workers and research.
 Most of the care provided will be at level 2
and will require the expertise of teams led
by experienced specialists e.g. General Surgery,
Orthopaedics, Internal Medicine, Paediatrics,
Obstetrics & Gynaecology, Family Medicine,
Radiology and Anaesthetics
and PHC 2014

 Services: Specialist and sub--specialist care to a
number of regional hospitals and also serve as a
platform for training of health workers and
research.
 Most care provided will be at level 3 and will
require the expertise of teams led by specialists
e.g. cardiology, cardiothoracic surgery,
craniofacial surgery, diagnostic radiology, ENT,
endocrinology, geriatrics, haematology, human
genetics, infectious diseases, general surgery,
orthopaedics, general medicine, paediatrics,
obstetrics & gynaecology, radiology and
anaesthetics.
and PHC 2014

 These hospitals render a very high
specialized tertiary and quaternary service on
a national basis and a platform for the
training of health workers and research.
 They also function as highly specialized
referral units for the other hospitals and
provide a high cost and low volume service.
 These hospitals employ high technology and
highly trained staff.
and PHC 2014

 Psychiatric Hospitals: Specialist psychiatric hospital
services to people with mental illness and
intellectually disability and provide a platform for
the training of health workers and research.
 Tuberculosis Hospitals: Hospitalization of acutely ill
and complex TB patients (including XDR &
MDR~TB).

 Rehabilitation Centres: Specialized rehabilitation
services for persons with physical disabilities,
including the provision of orthotic and prosthetic
services.
and PHC 2014

Fee structure
classification
and PHC 2014

http://www.doh.gov.za/docs/programmes/201
2/appendixH.pdf
To determine the service fee, patients are
divided into groups:
a. Full paying patients
b. Subsidised patients
c. Free services.
and PHC 2014

 This category of patients includes but is not
limited to:
◦ externally funded patients
◦ patients being treated by their
private practitioner
◦ certain categories of non-South
African citizens.
 They are liable for the full Uniform Patient Fee
Schedule (UPFS).
and PHC 2014

 Externally funded patients
◦ Compensation for Occupational Injuries and Diseases Act, 1993 (Act No 130 of
1993),
◦ Road Accident Fund created in terms of the Road Accident Fund Act, 1996 (Act No 56
of 1996),
◦ medical scheme registered in terms of the Medical Schemes
◦ Act, 1998 (Act No 131 of 1998).
◦ Patients treated on the account of:
 another state department,
 local authority,
 foreign government,
 any other employer.
 Patients treated by a private practitioner
 Non South African citizens – Excluding the following:
◦ immigrants permanently resident in the RSA but who have not
◦ attained citizenship
◦ non South African citizens with temporary residence or work
◦ permits
◦ persons from SADC states who enter the RSA illegally.
and PHC 2014

 H0 – patients qualifying for full subsidy:
◦ Social pensioners
◦ formally unemployed (registered at UIF)
◦ Re-classified by hospital admin
◦ Pregnant women and children under the age of 6
◦ Primary Health care services
◦ Termination of pregnancy and complications
thereof
and PHC 2014

Other subsidized services:
 Criminal procedure act (Assault, Rape, Post
mortem, Corporal Punishment)
 Child Care act
 Mental care Act
 Infectious, formidable and/or notifiable
diseases
 Malnutrition and pellagra
 Donors
and PHC 2014

 H1, H2 and H3 – partially subsidized (Means
test is used as baseline)
 See web site for the requirements and
services that are subsidized
and PHC 2014

 The H1 inpatient fee is expressed as a
percentage of 7 days of the UPFS General
Ward
 Inpatient fee to approximate the average
length of stay of inpatients in this category.
 Although the fee calculation is based on 7
days, for H1 patients this fee will be
applicable for each 30 days of inpatient stay
or part thereof.
and PHC 2014

Thank you
and PHC 2014

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