QuestionsQuestions (DOH ADMINISTRATIVE ORDER NO. 171, S. 2004)
It is issued to implement the relevant provisions of Republic Act No. 9257, the “Expanded Senior Citizens Act of 2003,” specifically by providing policies and guidelines to hospitals and related health facilities for the fair, just, and quality implementation of senior citizens’ health benefits and privileges.
It applies to all hospitals and health-related facilities (government and private), health care professionals, the Philippine Health Insurance Corporation (PhilHealth), and other related healthcare facilities and services, including drug stores/pharmacies and similar establishments dispensing medicines.
Medicines refer to both prescription and non-prescription medicines and articles approved by the BFAD for diagnosis, cure, mitigation, treatment, and prevention of disease and injury, excluding food and devices and their components/parts/accessories.
It is a drug not covered by patent protection, labeled solely by its international non-proprietary or generic name without a brand name.
(1) Free medically necessary services in subsidized sections (inpatient/outpatient) of government facilities; (2) 20% discount in non-subsidized/pay sections of government facilities; and (3) 20% discount in private health facilities, including specified related fees and professional fees, as well as a 20% discount for unbranded generic medicines.
When confined in service wards (subsidized in-patient and out-patient sections) of government health facilities, provided services are medically necessary and in accordance with available Clinical Practice Guidelines (CPGs) or Hospital Treatment Protocols.
A 20% discount on medically necessary medical and dental services and diagnostic/laboratory fees in pay sections, in accordance with CPGs or hospital treatment protocols.
Medically necessary medical and dental services, diagnostic and laboratory fees (e.g., X-rays, CT scans, blood tests), including professional fees of attending doctors and the use of specialized treatment rooms/equipment such as hemodialysis and radiotherapy.
Services not medically necessary (e.g., cosmetic surgeries, executive check-up packages, physical examinations without clinical evidence), and no discount is granted to special reagents, dyes, contrast media, and radioactive isotopes used in laboratory/diagnostic tests.
For government facilities, charges for services not included in subsidized services must be deducted and charged to the senior citizen’s PhilHealth coverage before PhilHealth reimbursement is pursued for subsidized services. For both government and private facilities applying the 20% discount, the 20% discount shall not be charged to PhilHealth benefits coverage; only the 80% expected share may be charged to PhilHealth coverage.
When the attending physician determines medical necessity consistent with CPGs/protocols; when DOH-endorsed evidence-based health screening tests are involved (if applicable to individual cases); when the requesting physician is a government-employed physician in the facility where tests will be conducted; and when no discounted exception applies to special reagents/dyes/contrast/radioactive isotopes.
Such outside requests are only granted a 20% discount upon final evaluation by the recipient government facility as medically necessary.
The attending dentist of the senior citizen determines medical necessity; if deemed medically necessary, the dental service is granted free in subsidized government wards or subject to the applicable 20% discount rules depending on the facility section (as provided in the Order).
The discount must be for exclusive use of senior citizens and must be supported by: the senior citizen’s identification document, a doctor’s prescription with specified details (including generic name, dosage form/strength, quantity, prescriber contact/license details), the OSCA purchase booklet information, and—if purchased by a representative—an authorization letter and ID. A generic menu card and official receipts stating usual vs. discounted prices must be provided.
As a general rule, any single dispensing should not be more than one (1) month supply, and partial filling rules require documentation in the special record book with the unfilled balance indicated.
They must post price lists of room rates in the admitting section and provide prices of diagnostics/laboratories (based on room/board accommodation), medical supplies, and medicines upon request. Official receipts must be issued for paid services and medicines, stating usual rates and the discounted price, with a billing statement attached showing both usual and discounted amounts.
For violations: first offense—fine of P50,000 to P100,000 and imprisonment of 6 months to 2 years; subsequent offenses—fine of P100,000 to P200,000 and imprisonment of 2 to 6 years. For abuse of privileges—fine of P5,000 to P50,000 and imprisonment of at least 6 months.
If a corporation/organization is the offender, the officials directly involved are liable. Proper authorities may also cancel or revoke business permits/franchises/other similar privileges after due notice and hearing upon filing of an appropriate complaint.
It takes effect immediately after publication in two (2) national newspapers of general circulation.