Legal Basis and Repeal
- Republic Act No. 747 mandates that rules and regulations be promulgated for its due execution regarding fees charged to patients in government hospitals and charity clinics.
- DOH Administrative Order No. 2015-0031 is issued in compliance with Republic Act No. 747 to implement its fee-regulation framework.
- Administrative Order No. 51-A s. 2001 and all other administrative orders implementing Republic Act No. 747 are repealed (Repealing Clause).
Policy, Purpose, and Rationale
- The Department of Health must provide support for patients with inadequate income to enable access to quality healthcare in government hospitals.
- The guidelines are issued using updated poverty and health-expenditure context, including poverty incidence of 25.8% and a national per capita poverty threshold range that includes P18,029 to P20,517 and P18,935 for the national per capita poverty threshold stated for ARMM.
- The objective is to update existing patient classification guidelines in government health care institutions and charity clinics.
- The objective is to set realistic patient classification guidelines based on financial capacity.
- The objective is to enable government health care institutions and charity clinics to classify patients with limited financial capacity for financial relief.
Coverage and Covered Institutions
- The guidelines apply to all government health care institutions and charity clinics (Scope).
- The Order governs patient classification for fee-sharing and fee charges in these government health care institutions and charity clinics (Scope).
Definitions of Patient Categories
- Eligible Beneficiaries are indigent or poor and partial pay patients.
- Indigent or Poor Patients are persons who cannot meet their basic needs, or who have income but are insufficient to fully meet their medical expenses, and who seek medical services in government hospitals or charity clinics as in-patient (including in a ward, ICU, or small private room) or out-patient.
- Partial Pay Patients are persons who can meet their basic needs but whose income is insufficient to fully meet their medical expenses, and who seek medical services as in-patient (including in a ward, ICU, or small private room) or out-patient in government hospitals or charity clinics.
- Full Pay Patients are persons who can meet their basic needs and who are in a large private hospital room or suite, with the capacity to meet the full cost of the medical treatment.
Patient Classification and Fee-Sharing Rules
- For an Indigent or Poor Patient, the hospital share is all expenses related to treatment of the patient, and the patient share is none (Patient Category table).
- For an Indigent or Poor Patient, the “all expenses” covered includes, among others:
- Laboratory and other diagnostic procedures, including minor and major surgical procedures, whether emergency or elective as required by the attending physician, except those for aesthetic purposes.
- All dental services such as examination and extraction, except prophylaxis and prosthesis.
- All drugs, medicines, and medical supplies as prescribed by the attending physician.
- Minimal professional fees on cases not covered by PhilHealth (example given: Reader’s fees).
- For a Partial Pay Patient, the hospital share is up to 90% of fees related to treatment, and the patient share is the remainder plus unpaid components identified in the table (Patient Category table).
- For a Partial Pay Patient, the covered “up to 90% of fees” includes, among others:
- Laboratory and other diagnostic procedures, including minor and major surgical procedures, whether emergency or elective as required by the attending physician, except those for aesthetic purposes.
- Dental services such as examination and extraction, except prophylaxis and prosthesis.
- All drugs, medicines, and medical supplies as prescribed by the attending physician.
- Minimal professional fees on cases not covered by PhilHealth (example given: Reader’s fees).
- The patient pays the portion of the hospital bill not covered by the partial payment.
- For a Full Pay Patient, the hospital share is none, and the patient share is all fees required by the hospital (Patient Category table).
- The classification framework distinguishes patient categories based on financial capacity and treatment context (such as room/suite category for Full Pay Patients).
Documentary Requirements for Classification
- Applicants must present documentary requirements for proper classification.
- Applicants may present a Latest Income Tax Return or a pay slip or other proofs of income.
- Applicants may present a Certificate of Indigency from the Department of Social Welfare and Development (including its local District Office or the Municipal Social Welfare and Development Office having jurisdiction over the applicant’s residence).
- Applicants may present a Certificate of Indigency from the Barangay Chairman having jurisdiction over the applicant’s residence.
Separability of Provisions
- If any part or provision of the Order is held invalid, the other provisions not affected remain in full force and effect (Separability Clause).