Facing a mounting R4.6 billion in unpaid patient fees, the Gauteng Department of Health has intensified revenue collection efforts while tightening payment controls in a bid to stabilise its strained finances.
Figures recently presented to the Portfolio Committee revealed that nearly half of the debt of about R2.4 billion, is owed by self-paying patients, including both South African citizens and foreign nationals, while the remainder is tied to unpaid intergovernmental claims and outstanding medical scheme payments.
In an effort to prevent the crisis from deepening, the department has begun enforcing upfront payment requirements for patients who do not qualify for free public healthcare. At the same time, it is rolling out enhanced patient identification and verification systems, including integration with national databases, to improve billing accuracy and strengthen its ability to trace defaulters.
However, officials acknowledge that recovering outstanding fees remains a significant challenge. A portion of the debt is considered difficult to collect, particularly in cases involving undocumented or untraceable foreign nationals. While these constraints persist, the department said it is exploring additional mechanisms including bilateral engagements to facilitate cost recovery.
Under current government policy, patients are classified based on income and supporting documentation. Those who qualify for free or subsidised care are required to provide identification and proof of income or unemployment, while patients who fall outside these thresholds are billed for services rendered.
Department spokesperson Kealeboga Mohajane said the department has ramped up recovery efforts through targeted debt collection strategies and strengthened internal billing systems, including the appointment of five debt collectors in 2025, which has so far yielded R28.8 million.
Recovery efforts, she said, are being driven through a structured approach focused on debt categories that are both traceable and legally enforceable, while internal systems are being strengthened to improve billing accuracy and overall revenue performance.
“As part of these efforts, the Department has strengthened its revenue collection capacity through participation in the Transversal Contract RT27-2024 for the provision of debt collection services to the State, managed by National Treasury for the period of 1 April 2024 to 31 March 2029.”
Mohajane added that processes are also underway to recover intergovernmental debt owed by entities such as the Road Accident Fund, the Department of Justice, SAPS, Correctional Services and other provinces.
She further revealed that targeted interventions have been introduced to improve medical aid claims management.
“This includes tightening billing controls, improving claims submission processes and addressing longstanding administrative gaps that have historically resulted in delayed or disputed payments by medical schemes,” she said.
Mohajane said the department was also enhancing patient administration systems to ensure that all patients liable for payment are correctly classified and billed for services rendered.
Despite ongoing recovery efforts, the department conceded that structural and administrative challenges continue to hamper collection, particularly in complex cases involving mobility, documentation gaps and intergovernmental claims.
The department maintains that it remains focused on strengthening internal systems, improving efficiency and maximising revenue collection within its legislative and operational mandate, as it seeks to safeguard the long-term sustainability of public healthcare services in the province.
The Star
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