Title
Universal Health Care Act of the Philippines
Law
Republic Act No. 11223
Decision Date
Feb 20, 2019
Republic Act No. 11223 establishes universal health care for all Filipinos, ensuring equitable access to comprehensive health services while protecting citizens from financial hardship through a reformed national health insurance program.

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
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