A government hospital in the Eastern Cape has ignited widespread outrage after reminding the public on its Facebook page that patients have to pay “file-opening fees”, reports News24.
However, the provincial Department of Health has said this is not a new initiative, and that the policy dates back 25 years.
Uitenhage Provincial Hospital – in Nelson Mandela Bay metro – said on its Facebook page that it charges R55 for opening a patient file during regular operating hours and R70 after hours. The fees are part of its guidelines aimed at ensuring “efficient and quality healthcare services”, it noted.
But the announcement has drawn sharp criticism.
Concerned citizen Laura Minnie commented that she wouldn’t believe such fees were required at a government facility unless confirmed by President Cyril Ramaphosa or the Minister of Health.
“I didn’t want to say anything, but I can’t keep my mouth shut. Who gets the money and what about our pensioners and the homeless? (Patients must) pay for a dirty hospital with no infection control, to lie on the floor, and not receive proper treatment. I can write a book about hospitals that don’t function properly,” she remarked on the post.
Helga Scheepers expressed frustration, saying the government should support citizens, not further burden them by asking for payment.
“I want to know where this money goes. Who is responsible for handling it, especially after hours when the hospital offices are closed? Poor people are being robbed every day. The government should be helping the public, not taking more from them,” she said.
During a visit by News24 to two other hospitals in the metro, patients said they had never been asked for such fees.
At Dora Nginza Hospital, Marcia Koopman said she had simply provided her ID and they had opened a file without asking for money.
Another patient said the same thing. “Aren’t government hospitals supposed to be free and covered by state funding?” she asked.
Similar sentiments arose at Livingstone Hospital, where Melissa Campher confirmed she had never been charged.
“I think it’s because I’m unemployed, but the idea of charging fees like this is a tactic to target and exploit the poor,” she said.
A patient waiting to be discharged said he’d overheard another patient saying he had to pay the hospital something. “I don’t know what the fee was for, but it’s disturbing that this is even happening.”
Community activist Kayzel Forbes described her shock upon seeing Uitenhage Provincial Hospital’s notice.
“We are speaking about a hospital attended by people who have only R20 left in their wallets and need to think twice before even using that R20.”
However, the Eastern Cape Department of Health said paying registration fees at public hospitals is nothing new, and that the Uniform Patient Fee Schedule (UPFS) had been implemented in South Africa in November 2000.
Required fees stretch much further than files but notices in public hospitals in this metro outline the fees patients must pay to see a doctor or specialist, based on their income, it said.
Departmental spokesperson Siyanda Manana said the UPFS standardises billing in the public health sector by categorising patients based on income and funding status to determine the fees to be charged.
“All public hospitals in the country adhere to the UPFS, not just one hospital in the Eastern Cape,” he said.
“Charging a fee to open a patient file is not a new implementation; it has been in place for years, with rates published annually.”
He said hospitals charge fees for services, except TB hospitals, where TB treatment is free unless the patient has medical aid. Clinics, on the other hand, provide primary healthcare services at no cost.
Manana said patients will not be denied access to healthcare, even if they cannot pay immediately.
In such cases, an account will be issued to them for later payment. He said the department follows up on outstanding payments through phone calls and verbal communication, with plans to introduce an SMS reminder system for debtors.
“Patients who are required to pay can settle their fees using cash or card, as facilities have card options. A receipt is issued immediately, and the collected funds are deposited into the bank by the revenue section. In cases where immediate banking is not possible, funds are stored in a safe,” he said.
On the patient registration process, he added: “Even if a patient has an existing file, the registration process must still be completed and fees are payable for each consultation. Each hospital holds its own unique bank account, which is linked to the department’s main account.
Patients with no money will not be turned away, he told TimesLIVE, reaffirming that healthcare is a constitutional right, and that no one may be refused emergency medical treatment.
“It is a similar approach in terms of indigent people or pensioners who receive government aid because of their status. People are not disadvantaged and denied care just because of their economic or social status.”
Manana also outlined the UPFS patient categories, which are based on income and determine applicable fees:
H0: Pensioners are not required to pay unless they have medical aid.
H1: People earning less than R70 000 annually, with a household income below R100 000.
H2: People earning less than R250 000 annually, with a household income below R350 000.
H3: People earning more than R250 000 annually, with a household income exceeding R350 000.
Manana said H2 patients are subject to fees like R55 for regular hours and R70 for after-hours consultations.
H3 patients, often covered by medical aid, are charged based on services rendered.
According to a UPFS notice at Dora Nginza’s outpatient department, updated in April 2025, H1 and H2 patients may pay up to R55 to see a general practitioner, while H3 patients may pay up to R82.
An emergency consultation with a general practitioner may cost H1 and H2 patients R100 and H3 patients R145.
The notice states that X-rays and medication are included in the initial fees for H1 patients only.
News24 article – Eastern Cape public hospitals under fire over file-opening fees (Restricted access)
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