Legal basis and repealed/modified provisions
- Republic Act No. 9439 prohibits detention of patients in hospitals and medical clinics on grounds of nonpayment of hospital bills or medical expenses.
- Section 4 of Republic Act No. 9439 authorizes the Department of Health to promulgate the necessary rules and regulations to implement the law.
- Republic Act No. 9439 repeals or amends pertinent provisions of the Revised Penal Code, particularly Articles 267, 268, and 270, insofar as they involve hospitals or medical clinics, medical practitioners, and their staff and employees.
- Prior provisions inconsistent with this Administrative Order are rescinded and modified accordingly.
- If any provision of this Administrative Order is declared unauthorized or invalid by any court of law or competent authority, the remaining provisions remain valid and effective.
Purpose and policy objectives
- Republic Act No. 9439 addresses the problem of hospitals and medical clinics refusing to discharge patients due to inability to pay by encouraging the use of appropriate payment schemes instead of detention.
- Patients are required to honor their obligation to pay hospital bills or medical expenses where they execute the required payment instruments.
- Hospitals and medical clinics are required to follow lawful release and documentation procedures aligned with the prohibition against detention for nonpayment.
Definitions for RA 9439 implementation
- A “Co-Maker” is a person, natural or juridical, who binds himself jointly and severally to pay the unpaid hospital bills or medical expenses/hospitalization expenses of the patient.
- A “Complaint” is a sworn written statement of ultimate facts, filed by the patient, charging the official or employee of the hospital or medical clinic with any violation of Republic Act No. 9439 and its implementing rules and regulations.
- “Detention” is the act of restraining a person from leaving hospital premises for nonpayment of hospital bills or medical expenses in part or in full.
- A “Guarantee” is an expressed assurance by the co-maker to the hospital or medical clinic that certain facts or conditions are true and/or will happen; the hospital or medical clinic may rely on the assurance and seek action if it is not true and/or not followed.
- A “Hospital” is a health facility for diagnosis, treatment, and other health care of individuals suffering from deformity, disease, illness or injury, or needing surgical, obstetrical, medical or nursing care, including institutions with installed bassinets or beds for 24-hour use or longer by patients in the management of such conditions and maternity cases.
- “Hospital Bills or Medical Expenses/Hospitalization Expenses” are costs of diagnosis, treatment, and other forms of health care, including (but not limited to) doctor’s fees, amounts owing for clinical and ancillary services, and charges for room, meals, medical supplies, drugs and medicines, and payments for use of equipment.
- A “Medical Clinic” is a health facility that meets the Hospital definition but uses the phrase “medical clinic” in its business name.
- A “Mortgage” is a method of using real property (land) or personal property as security for payment of a debt.
- An “Officer or Employee hospital or medical clinic” is a person acting for a hospital or medical clinic responsible for releasing patients in accordance with the hospital’s or clinic’s written policies and procedures.
- A “Patient” is a person already admitted and availed of health care services in a hospital or medical clinic.
- “Private Room” is a single occupancy room or a ward type room divided by a permanent or semi-permanent partition (except curtains) not to exceed 4 patients per room, admitted for diagnosis, treatment, and other forms of health care maintenance.
- A “Promissory Note” is an unconditional written promise by the patient and/or his/her next of kin to the hospital or medical clinic to pay on demand, or at a fixed or determinable future time, a sum certain in money, payable to order or to bearer.
Coverage and key exceptions
- This Administrative Order applies to patients admitted in government and private hospitals and medical clinics.
- This Administrative Order applies to both hospitals and medical clinics.
- The rules apply except those who stay in private rooms.
Core release policy and lawful alternatives
- Patients except those who stay in private rooms who are partially or fully recovered and who wish to leave but are incapable to pay hospital bills or medical expenses/hospitalization expenses in part or in full must be allowed to leave.
- The hospital or medical clinic must issue the corresponding medical certificate and other pertinent documents for release once the required payment instrument is executed.
- The patient’s departure requires execution of a promissory note covering the unpaid obligations.
- The promissory note must be secured by either:
- a mortgage, or
- a guarantee of a co-maker who is jointly and severally liable.
- For a deceased patient, surviving relatives must be issued the corresponding death certificate and other pertinent documents for interment purposes only.
- For purposes other than interment, the hospital may release documents only after execution of a promissory note covering unpaid obligations by any surviving relative, secured by mortgage or joint and several guarantee by a co-maker.
- For benefits claims related to the Social Security System, Government Service Insurance System, Philippine Health Insurance Corporation, insurance policies, or pre-need plans, the hospital may require an assignment of proceeds up to the extent of hospital bills or medical expenses/hospitalization expenses.
- If surviving relatives refuse to execute a promissory note for a deceased patient, they must be allowed to claim the cadaver and may demand issuance of death certificate and other pertinent documents for interment purposes; documents for other purposes require execution of the promissory note.
When detention is deemed unlawful
- A hospital or medical clinic that detains or causes detention of a patient for nonpayment in part or in full must be held accountable for an unlawful act.
- Detention exists when all of the following circumstances are present for a living patient:
- the patient has expressed intention to leave after partial or full recovery, or the attending physician has issued a discharge order;
- the patient is not confined in a private room and is financially incapable to settle the corresponding bills in part or in full;
- the patient has executed a promissory note covering the unpaid obligations; and
- the officer or employee responsible for release has restrained the patient from leaving hospital premises.
- Detention exists for a deceased patient when all of the following circumstances are present:
- a medical officer has made the pronouncement of death;
- any surviving relative is incapable to pay the corresponding bills/expenses in part or in full;
- any surviving relative has executed a promissory note covering unpaid obligations; and
- the officer or employee responsible for release has refused to release the cadaver and/or relevant documents.
Specific implementation guidelines
- Hospitals and medical clinics and patients are directed to observe classification, admission, billing, and discharge practices to minimize incidents of inability to pay and detention.
- Government hospitals/medical clinics must classify patients according to DOH guidelines under Administrative Order No. 51-A s. 2000, titled “Implementing Guidelines on Classification of Patients and on Availment of Medical Social Services in Government Hospitals”, dated October 12, 2001.
- Private hospitals/medical clinics must have written policies and procedures to classify patients according to their capacity to pay, and may refer to AO No. 51-A s. 2000.
- Hospitals and medical clinics must assist patients in seeking financial assistance from government and non-government sources; the DOH must work closely with organizations including Philippine Health Insurance Corporation, Philippine Charity Sweepstakes Office, Philippine Amusement and Gaming Corporation, Local Government Units, and Congress to provide funds for this purpose.
- Hospitals and medical clinics must establish billing and collection procedures subject to current accounting and auditing rules and regulations.
- Hospitals and medical clinics must establish written policies and procedures for admitting and releasing patients, including identifying the officer/s or employee/s responsible for releasing patients.
Promissory-note execution requirements
- Except for private-room patients, partially or fully recovered patients who wish to leave but are incapable to pay must execute a promissory note secured by either:
- a mortgage, or
- a guarantee of a co-maker.
- For deceased patients, any surviving relative must execute a promissory note secured by either:
- a mortgage, or
- a guarantee of a co-maker.
- Hospitals and medical clinics must have written policies and procedures for execution of promissory notes secured by either a mortgage or a guarantee of a co-maker.
Administrative offense penalties
- Any officer or employee of a hospital or medical clinic responsible for releasing patients who commits a violation of Republic Act No. 9439 and its implementing rules and regulations must be punished by either:
- a fine of not less than PHP 20,000 but not more than PHP 50,000, or
- imprisonment of not less than 1 month but not more than 6 months, or both such fine and imprisonment, at the discretion of the proper court.