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Department of Health, Philippines

Universal Health Care Act

Republic Act No. 11223

Nimfa B. Torrizo, MD, MPHDirector IV

Department of Health Center for Health Development-Northern Mindanao


President Rodrigo Roa Duterte led the Signing of the Universal Health Care Act (RA 11223) at the Malacañan Palace on February 20, 2019


Declaration of Principles

• Integrated and comprehensive approach to ensure healthliteracy, healthy living, and protection from hazards and risks

• Health care model that provides comprehensive healthservices without causing financial hardship

• Whole-of-system, whole-of-government, whole-of-society approach in the development of health policies

• People-oriented approach centered on people’s needs andwell-being


General Objectives

• To progressively realize Universal Health Care throughsystemic approach and clear role delineation ofstakeholders

• To ensure equitable access to quality and affordablehealth care and protection against financial risk


o Population coverage

o Service coverage

o Financial coverage

Universal Health Care Act


Universal Health Care

Population Coverage – automatic inclusion of every Filipinocitizen into the NHIP

Service Coverage

• immediate eligibility and access to population-based andindividual-based health services

• comprehensive outpatient benefit package

• provision of primary care provider


Universal Health Care

Financial Coverage

Population-based health services

• funded by National Government through DOH

• free at point of service

Individual-based health services

• primarily through pre-payment mechanisms (SHI, PHI,HMOs)


National Health Insurance Program

Membership

• Direct contributors – those who have the capacity to pay premiums

• Indirect contributors – those whose premiums aresubsidized by the national government


National Health Insurance Program

Entitlement to Benefits

• immediate eligibility

• no co-payment in basic or ward accommodation

• co-payment and co-insurance for amenities in publichospitals regulated by DOH and PhilHealth

• no reduction in current PhilHealth package

• additional benefits for direct contributors, where applicable


Health Services Delivery

Population-based Health Services

• DOH to contract province-wide and city-wide healthsystems

• Minimum components:

primary care provider network

epidemiologic surveillance systems

health promotion programs/campaigns


Health Services Delivery

Individual-based Health Services

• Philhealth to contract public, private or mixed health careprovider networks

service quality

co-payment/co-insurance

data submission

• PhilHealth and DOH to incentivize health care providersthat form networks


Health Services DeliveryIndividual-based Health Services

• DOH to determine apex or end-referral hospitals; may becontracted by PhilHealth as stand-alone providers

• PhilHealth to:

shift to performance-driven, close-end, prospectivepayments based on DRGs, validated costing methods, andno differentiation between facility and professional fees

develop differential payment considering service quality

institute strong surveillance and audit mechanisms


Health Service Delivery

13

Population-Based [Sec 4(q)] Individual-Based [Sec 4(p)]

What is it? Primary care provider network,

epidemiologic surveillance systems, and

Health promotion programs (Chapter 4,

Sec 17)

Services access within a health facility or

remotely (ambulatory, inpatient care,

medicines, lab tests)

Recipients Population groups (barangays,

municipalities)

One individual or recipient

Provider Province-wide and city-wide health

systems (Chapter IV, Sec 17)

Public, private or mixed health care

provider networks (Chapter IV, Sec 18)

Payer DOH PhilHealth

Population-Based Health Services

Preventive - Promotive

Individual-Based

Health Services

Curative - Rehabilitative

(With Report from ZFF)


Organization of Local Health Systems

Integration into Province-wide and City-wide HealthSystems

• Provincial/City Health Board to:

oversee integration of health services

manage the special health fund

exercise administrative and technical supervision over healthfacilities and HRH within their jurisdiction

• Municipalities and cities to be represented in the Board



Special Health Fund

• Province-wide and City-wide Health System shall pooland manage all resources in order to finance population-based and individual-based health services

• DOH, in consultation with DBM and LGUs, shall developguidelines for Special Health Fund



Income derived from PhilHealth payments

• PhilHealth payments shall accrue to the Special Health Fundand credited as Annual Regular Income (ARI) of the LGU

Incentives for improving competitiveness of the PublicHealth Service Delivery System

• National Government to provide financial and non-financialmatching grants in accordance with province-wide and city-wide investment plans


Human Resources for Health

National Health Human Resources Master Plan

• Provision of policies and strategies for appropriate healthworkforce based on population needs, and for guaranteedpermanent employment and competitive salaries

National Health Workforce (NHW) Support System

• Support to local public health systems in addressing humanhealth needs, especially for GIDAs


Human Resources for HealthScholarship and Training Program

• expansion of existing and new health related degree andtraining programs

• regulation of the number of enrollees based on health needs

• expansion of scholarship grants for undergraduate andgraduate programs

• setting-up of registry of medical and allied health professionals

• reorientation of health professional education, certification andregulation towards provision of primary care services


Human Resources for Health

Return Service Agreement

• return service for at least three (3) years for recipients ofgovernment-funded scholarship programs

• provision of additional incentives for those rendering additionaltwo (2) years of service

• establishment of guidelines for non-compliance


Regulation

Safety and Quality

PhilHealth to:

• establish a rating system under an incentive schemebased on service quality, efficiency and equity

• recognize third party accreditation mechanism


Regulation

Safety and Quality

DOH to:

• institute a licensing and regulatory system for stand-alone health facilities, ambulatory and primary careproviders

• set standards for clinical care through development anduse of clinical practice guidelines


Regulation

Affordability

• Procurement of Drugs and Devices of DOH-owned Health Care Providers

follow centrally negotiated prices

sell in prescribed maximum mark-ups

submit a price list of all drugs/devices procured and sold

• Independent Price Negotiation Board

negotiate prices on behalf of DOH and PhilHealth


Regulation

Affordability

• health care providers to make price information of healthgoods and services readily accessible

• drug outlets to carry the generic equivalent of all drugs inthe Primary Care Formulary

• DOH, PhilHealth, HMOs and PHIs to develop policies andplans for complementation of health benefits


Regulation

Equity

• preferential licensing of health facilities and contracting of healthservices for underserved areas

• equitable distribution of health services and benefits prioritizingGIDA

• all government hospitals to operate not less than 90% of bedcapacity as basic accommodation; specialty hospitals not lessthan 70%; private hospitals not less than 10%


Governance and Accountability

Health Promotion

Transformation of HPCS to Health Promotion Bureau

• formulation of strategy for increasing health literacy

• implementation of health promotion programs and activitiesacross social determinants of health

• policy coordination across government instrumentalities

• provision of technical support to local research anddevelopment



Health Promotion

• at least one percent (1%) of total DOH budget earmarkedfor health promotion programs

• DepEd schools to be designated as healthy settings

• incorporation of health promotion in school curricula

• LGU to enact stricter ordinances to promote healthliteracy and healthy lifestyle



Evidence-Informed Sectoral Policy and Planning for UHC

• all health-related entities to submit health data to PhilHealth

• DOH and DOST to develop cadre of policy systemsresearchers, experts and managers through training grants

• administrative and survey data generated using public fundsconsidered as public records and made accessible to the public

• action researches on health promotion and social mobilizationas part of the national health research agenda



Monitoring and Evaluation

• PSA to conduct relevant modules of household surveys annuallyfor the first ten (10) years of implementation

• DOH to publish annual provincial burden of disease estimates

Health Impact Assessment

• HIA as requirement for all policies, programs and projects



Health Technology Assessment

• institutionalizaton of HTA process to inform policies anddecisions of DOH and PhilHealth

• creation of HTAC within DOH

• within five (5) years after establishment, HTAC to be anindependent entity separate from DOH, attached to DOST



Ethics in Public Health Policy and Practice

• declaration and management of conflict of interest

• collection and tracking of financial relationships with healthcare professionals/providers for all manufacturers of drugs,medical devices, and medical supplies registered by FDA

• Public health ethics committee as an advisory body to theSecretary of Health



Health Information System

• health service providers and insurers to maintain a healthinformation system to be electronically uploaded on aregular basis through interoperable system

• enterprise resource planning

• human resource information

• electronic health records

• electronic prescription log


Appropriations

Source of Funding for UHC

• Total incremental sin tax collections

• 50% of the National Government share from PAGCOR

• 40% of the Charity Fund, net of Documentary Stamp Tax Paymentsand mandatory contributions of PCSO

• Premium contributions of members

• Annual appropriations of the DOH

• National Government subsidy to PhilHealth

• Supplemental funding


When will the UHC Act be effective?

● The law is already in effect as per Sec. 46, which

provides that: “(The) Act shall take effect fifteen (15) days

after its publication in the Official Gazette or in any

newspaper of general circulation.”

● However, it cannot be implemented until an IRR has

been promulgated by the DOH and PhilHealth. Sec. 43

provides that the IRR should be developed not later than

180 days upon the effectivity of the Act.


Summary - Financing

34

Clarifying roles: 1.DOH and LGU for

population-based services 2. PhilHealth for individual-

based services

Pooling funds to PhilHealth for all individual-based health services (e.g. Sin Tax, PAGCOR, PCSO)

Simplifying membership into two types: Direct and Indirect Contributory

Contracting by network based on adherence to quality and co-payment standards + third party accreditation


Summary - Service Delivery

35

Institutionalizing primary care as a prerequisite to

access higher level of care and contracting by network

Consolidating fragmented providers into province-wide and city-wide

service delivery networks to navigate and coordinate

Enabling income retention for all public providers through

a Special Health Fund


Summary - Regulation

36

Mandating transparent pricing of health goods and services

Basic and non-basic accommodation bed ratio of 90:10 for government hospitals, 70:30 for specialty hospitals, and 10:90 for private hospitals

Ensuring benefit complementation between PhilHealth and Private Health Insurance (PHIs) and Health Maintenance Organizations (HMOs)

Expanding scholarship programs, requiring 3 years return service in underserved areas for government scholars, augmenting HRH through national health workforce support system, primary care-oriented education, health professionals registry


Summary - Governance

37

Requiring submission of health and financial data by healthcare providers and suppliers harmonized to an interoperable system; sharing of publicly-funded data sets

Institutionalizing Health Technology Assessment as prerequisite for public financing of goods/services, and Health Impact Assessment for various programs, policies, and projects

Strengthening Health Promotion and medicines procurement

Streamlining PhilHealth Boardfrom 17 to 13 members

Maraming salamat po!

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