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On average, public hospitals are collecting only about half of the money that they billed patients for health care in the 2008/09 financial year. This must be seen in the context of the fact that patients are charged according to their income, and receive free services if they are impoverished. The low average payment rate occurred despite many provincial governments acting strongly to recover fees owed for several years by the Road Accident Fund, resulting in some hospitals collecting significantly more during the year than they charged patients. Greenville Hospital in the Eastern Cape, for example, levied only R3 000, but collected R93 000. On the other hand, however, many hospitals make little effort to recover fees. Grobesdal Hospital in Limpopo, for example, billed patients for R560 000 and only collected R2 000. Public hospitals are not private companies. They are not supposed to make a profit and they will always need state subsidies. But it makes no sense to allow a significant source of income to go to waste. With the money not collected last year, almost R800m, more than 3 600 doctors could have been employed. The DA believes that there are two main problems: The first is the poor quality of many of our hospital CEOs, who are chosen on party loyalty not ability. The enormous variation in collection rates between hospitals suggests that some CEOs take the problem of collecting fees seriously, and some do not. The second problem is that there is no incentive on the part of hospitals to collect fees, because fees must be paid over to the provincial government. While hospitals must provide staff to issue bills and collect payments, they see none of the benefit of this. There is an urgent need to decentralise the hospital management system to allow fees to be retained where they are needed. Overall collection statistics1
Province Total amount levied Amount collected Amount not collected % collected
W Cape R442m R257m R185m 57%
North West R34m R22m R12m 65%
Mpumalanga R46m R35m R11m 76%
Limpopo R118m R18m R100m 15%
Gauteng R696m R303m R393m 44%
Eastern Cape R82m R59m R23m 72%
KwaZulu-Natal R96m R93m R3m R97%
Total R1 514m R787m R727m R52%
1. Two provinces, the Northern Cape and the Free State, did not provide answers

Top five worst collectors 2008/09

Province Hospital Amount levied Amount collected Percent Collected
1 Limpopo Grobesdal R560 000 R2 000 0%
2 Limpopo Polokwane R37m R1.3m 4%
3 Limpopo Mankweng R19m R970 000 5%
4 Mpumalanga Carolina R428 000 R26 000 6%
5 North West Zeerust R488 000 R36 000 7%
Top five best collectors 2008/09

Province Hospital Amount levied Amount collected Percent Collected
1 Eastern Cape Greenville R3 000 R93 000 3100%
2 Eastern Cape St Barnabus R10 000 R280 000 2800%
3 KwaZulu-Natal Appelbosch R7 000 R159 000 2271%
4 Eastern Cape Isilimela R2 000 R42 000 2100%
5 KwaZulu-Natal St Francis R7000 R73 000 1043%