Question & AnswerQ&A (Republic Act No. 11223)
The short title of Republic Act No. 11223 is the "Universal Health Care Act".
The State's main policy is to protect and promote the right to health of all Filipinos and instill health consciousness among them through a comprehensive, integrated, and people-oriented health care approach.
Direct contributors are those who have the capacity to pay premiums, including gainfully employed individuals under an employer-employee relationship, self-earning individuals, professional practitioners, migrant workers, including their qualified dependents, and lifetime members.
Emergency refers to a condition or state of a patient wherein immediate danger exists and delay in support and treatment may cause loss of life or permanent disability, or, in the case of a pregnant woman, permanent injury or loss of her unborn child, or a non-institutional delivery.
Every Filipino citizen shall be automatically included into the National Health Insurance Program (NHIP), ensuring universal membership.
Population-based health services are financed by the National Government through the Department of Health and provided free of charge at point of service, while individual-based health services are financed primarily through prepayment mechanisms such as social health insurance, private health insurance, and HMO plans.
A health care provider committing a fraudulent act may be fined Php 200,000 per count, suspended for up to three months or the remaining contract period, or both. This also constitutes a criminal offense punishable by imprisonment from six months and one day up to six years.
The PhilHealth Board of Directors consists of a maximum of thirteen (13) members: five ex-officio members (secretaries of key departments), three expert panel members with relevant expertise, and five sectoral panel members representing various sectors including direct and indirect contributors, employers, health care providers, and local chief executives.
HTAC facilitates financing and coverage recommendations, oversees and coordinates the HTA process in the Department of Health and PhilHealth, and reviews existing benefit packages to ensure evidence-based and ethical prioritization of health technologies and interventions.
Unethical acts include overbilling, upcoding, harboring ghost patients, recruitment malpractice, or any other practices that violate the Code of Ethics of the professional involved, undermining the integrity and effective implementation of the NHIP.
No more than seven and one-half percent (7.5%) of the actual total premiums collected from members shall be allocated to the administrative costs of the program.
The Act mandates integration of municipal and city health systems into province-wide and city-wide health systems overseen by Provincial and City Health Boards, which manage a Special Health Fund to finance health services and system operations.
Employers who deliberately or negligently fail to register employees, deduct, or remit contributions face fines of Php 50,000 per affected employee or imprisonment of six months to one year, or both. Deducting the employer's share from employees' compensation is punishable by a fine of Php 5,000 multiplied by the number of affected employees or imprisonment of six months to one year, or both.
Health professionals and workers are guaranteed permanent employment and competitive salaries to ensure continuity in health programs and services.
Funding comes from incremental sin tax collections, government shares from PAGCOR and PCSO, premium contributions of members, annual appropriations included in the General Appropriations Act, and national government subsidies to PhilHealth.