UPFS


Uniform Patient Fee Schedule

 

It groups patients into three categories defined in general terms, and includes a classification system for placing all patients into either one of these categories depending on the situation and any other relevant variables. The three categories include full paying patients—patients who are either being treated by a private practitioner, who are externally funded, or who are some types of non-South African citizens—, fully subsidised patients—patients who are referred to a hospital by Primary Healthcare Services—, and partially subsidised patients—patients whose costs are partially covered based on their income. There are also specified occasions in which services are free of cost.[5]The public sector uses a Uniform Patient Fee Schedule as a guide to billing for services. This is being used in all the provinces of South Africa, although in Western Cape, Kwa-Zulu Natal, and Eastern Cape, it is being implemented on a phased schedule. Implemented in November 2000, the UPFS categorises the different fees for every type of patient and situation.
Aim of the UPFS
  • A uniform patient fee schedule suitable for use in all public hospitals and applicable to externally funded patients:
  • Medical scheme members
  • Road Accident Fund beneficiaries
  • Workmen’s Compensation beneficiaries
  • Inter-departmental charges:
  • Correctional Services, SA Police Service.
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Objectives of the UPFS
  • Simple to implement in both manual and computerised systems
  • Should be based on health service activities
  • Related to BHF Scale of Benefits
  • Easy to adjust for changes in cost structure
  • Different levels of health service delivery should be taken into consideration
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Basic Principles of Uniform Patient Fee Schedule
  • Two Components of Fee
  • Facility
  • Professional
  • Separated to enable hospitals to recover costs when private healthcare professional using public facilities to treat patients
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Principles of Uniform Patient Fee Schedule
  • Facility Fee
  • the charge for providing the healthcare environment
  • Levels 1 & 2
  • Level 3
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Principles of Uniform Patient Fee Schedule
  • Facility Fee cont
  • Level 1 District Hospitals
  • Level 2 Regional Hospitals
  • Level 3 Academic Hospitals

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  • Professional Fee
  • the charge for the professional responsible for
delivering the service to the patient.

  • Where more than one category of professional
delivering the service, charge highest level

  • Private Practitioner - no professional fee levied
by hospital

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