Law Summary
Declaration of Principles and Policies
- The State aims to protect and promote the right to health of all Filipinos.
- It adopts an integrated and comprehensive approach focused on health literacy, healthy living conditions, and protection from health hazards.
- Health care model ensures access to a comprehensive range of quality, cost-effective health services without causing financial hardship.
- Emphasizes a whole-of-system, government, and society approach in health policy development and implementation.
- Health services are people-centered, respecting cultural and value differences.
General Objectives
- To progressively realize universal health care through systemic approaches and clear agency roles.
- Guarantee equitable access to quality and affordable health care and protection from financial risks.
Definitions
- Provides detailed definitions of key terms including abuse of authority, amenities, co-insurance, co-payment, direct and indirect contributors, emergency, entitlement, health care provider and network, Health Technology Assessment (HTA), individual-based and population-based health services, primary care and provider, private health insurance, and unethical acts.
Population Coverage
- Every Filipino citizen is automatically included in the National Health Insurance Program (NHIP).
Service Coverage
- Provides immediate eligibility and access to comprehensive health care services, including preventive, promotive, curative, rehabilitative, and palliative care.
- PhilHealth to implement outpatient benefits and emergency medical services within two years.
- DOH and LGUs to establish primary care providers as navigators in the health system.
- Registration of every Filipino to a primary care provider of choice is mandated.
Financial Coverage
- Population-based health services financed by the National Government and provided free of charge.
- Individual-based services financed primarily through prepayment schemes like social health insurance, private insurance, and HMOs.
Program Membership
- Simplified into two types: direct contributors (with capacity to pay) and indirect contributors (subsidized by the government).
Entitlement to Benefits
- Immediate eligibility for benefits with no required PhilHealth ID card.
- No co-payment for basic or ward accommodations; regulated co-payments for amenities.
- Continued benefits even if premiums are unpaid.
- Employers and self-employed must pay missed contributions with interest.
Premium Contributions
- Detailed schedule of premium rates and income brackets from 2019-2025.
- Premium subsidies for indirect contributors included in annual General Appropriations Act.
- Benefit increases correspond with contribution increases.
Reserve Funds
- PhilHealth to set aside reserve funds capped at two years’ projected expenditures.
- Excess reserves to enhance benefits or reduce contributions.
- Investment reserve funds to be invested in government bonds, corporate bonds, domestic banks, stocks, and medical institution bonds with specified limits.
- Specific funds established for lifetime members and supplemental benefits managed actuarially.
Administrative Expense Limit
- Administrative costs capped at 7.5% of premiums collected from contributors.
PhilHealth Governance
- Board of Directors composed of 13 members from government, experts, and sectoral representatives with defined qualifications.
- Secretary of Health as nonvoting chair.
- Mandatory training in health care financing and systems for board members.
- Appointment procedures for Board and CEO specified.
PhilHealth President and CEO
- Must have seven years’ relevant experience.
- Appointed by the President of the Philippines upon Board recommendation.
PhilHealth Personnel
- Classified as public health workers under the Magna Carta of Public Health Workers.
Additional Powers of PhilHealth
- Fix compensation subject to the President’s approval.
- Establish organizational structure and staffing.
- Maintain provident fund for personnel.
- Adopt and approve budget within prescribed administrative expense limits.
Health Services Delivery: Population-based
- DOH to contract province-wide and city-wide health systems with primary care networks, epidemiologic surveillance, and health promotion programs.
Health Services Delivery: Individual-based
- PhilHealth to contract with provider networks ensuring service quality and data standards.
- Shift towards performance-based and prospective payment systems.
Organization of Local Health Services
- Integration of local health systems into province-wide and city-wide systems.
- Health Boards oversee integration and manage special health funds.
Special Health Fund
- Pool and manage health resources for services, investments, salaries, and incentives.
- Guidelines to be developed by DOH with DBM and LGUs.
Income from PhilHealth Payments
- Accrues to the Special Health Fund for LGU health system improvements.
Incentives for Public Health Service Improvement
- Financial and non-financial grants to improve health system functionality, prioritizing underserved areas.
Human Resources for Health: Master Plan
- DOH to formulate and implement a master plan for health workforce generation, recruitment, retention, and regulation.
- Guarantee permanent employment and competitive salaries.
National Health Workforce Support System
- Established to support local public health systems, prioritizing Geographically Isolated and Disadvantaged Areas (GIDAs).
Scholarship and Training
- CHED, TESDA, PRC, and DOH to expand allied health programs and scholarships focused on underserved areas.
- Create a registry of medical and allied health professionals.
- Reorient education towards primary care competencies.
Return Service Agreement
- Scholarship recipients must serve at least three years in priority public areas.
- Additional incentives for longer service.
- Implementation coordinated between DOH, CHED, and PRC.
Regulation: Safety and Quality
- PhilHealth to establish rating and incentive systems for health facilities.
- DOH to license and regulate stand-alone facilities.
- Development of clinical care standards with professional societies.
Affordability
- DOH-owned providers to follow price reference guides.
- Independent price negotiation board to manage drug and device prices.
- Health care providers must disclose pricing publicly.
- Drug outlets must carry generics and provide therapeutic equivalents.
- Coordination among public and private insurers to harmonize benefits.
Equity
- Underserved areas annually updated for preferential licensing and contracting.
- Geographic prioritization of services.
- Mandatory bed allocations for basic or ward accommodations in government, specialty, and private hospitals with reporting requirements.
Governance and Accountability: Health Promotion
- DOH to strengthen health promotion and literacy, transforming its Health Promotion unit into a Bureau.
- Schools designated as health settings with integrated curricula.
- LGUs to enact ordinances and programs to promote health literacy.
- Annual reporting to national officials.
Evidence-Informed Policy and Planning
- Mandatory submission of health data by public and private entities to PhilHealth and DOH.
- Support for health systems research and training of policy researchers.
- Transparency and accessibility of health data.
Monitoring and Evaluation
- PSA to conduct annual health surveys initially.
- DOH to publish disease burden estimates.
Health Impact Assessment
- Required for policies, programs, and projects impacting health outcomes.
Health Technology Assessment (HTA)
- Institutionalized to guide DOH and PhilHealth coverage decisions.
- Based on criteria: magnitude, safety, financial impact, cost-effectiveness, affordability.
- HTA Council created within DOH, to become independent within five years.
- Transparent process, public dissemination of results.
- Detailed composition, terms, and nomination process for HTA Council.
Ethics in Public Health Practice
- Mandatory conflict of interest declarations.
- Transparency on financial relationships of manufacturers with providers.
- Establishment of a public health ethics committee.
Health Information System
- All health providers and insurers to maintain interoperable health information systems funded by DOH and PhilHealth.
- Patient privacy fully protected per Data Privacy Act.
Appropriations
- Funded from sin tax collections, PAGCOR shares, PCSO charity funds, member contributions, DOH appropriations, and government subsidies.
- Supplemental funding may be requested by DOH and PhilHealth.
Penal Provisions
- Sanctions for health care providers violating contracts, including fines, suspensions, and criminal liability for unethical or fraudulent acts.
- Penalties for members who violate the Act.
- Employer sanctions for failure to remit contributions or unlawful deductions.
- Liability for PhilHealth officers for misappropriation, unethical acts, and abuse of authority.
- Provisions for mitigation and aggravation of liabilities.
- Continuation of proceedings despite cessation of provider operations.
Oversight and Monitoring
- Creation of a Joint Congressional Oversight Committee to review implementation.
- Performance monitoring division established in DOH.
- Annual and independent evaluation reports required.
Transitory Provisions
- Immediate appointment of new PhilHealth Board and CEO.
- Continuation of existing personnel without reduction in benefits.
- Absorption and retirement programs for PCSO employees.
- Technical and financial support for LGUs integrating health systems.
- Timeline for integration and outsourcing functions.
- Establishment of HTA Council and development of co-payment systems within set periods.
- Certification requirements for primary care providers.
Interpretation and Implementing Rules
- Doubts resolved in favor of upholding Filipino rights to quality health care.
- No reduction in existing benefits.
- DOH and PhilHealth to promulgate implementing rules within 180 days.
Separability, Repealing, and Amendments
- Partial invalidity of provisions does not affect remaining