PUBLIC POLICY ANALYSIS: HEALTH SECTOR
UNIVERSAL HEALTH CARE (UHC) LAW
Presented to the Faculty of the
College of Business Administration
University of the Cordilleras
In Partial Fulfillment
Of the Requirements for the Course
Public Policy and Program Administration for Development (MSDM M007)
Submitted by:
Rico-Ocuaman, Erika Charmain Faye
Sastre, Ma. Teresa Diane
Submitted to:
Ms. Doreen I. Allasiw, Ph.D.
Adviser
March 6, 2023
The Universal Health Care (UHC) ensures that all Filipinos have fair access to
high-quality, reasonably-priced health care products and services as well as protection
from financial risk. It includes extensive and forward-thinking measures that will
guarantee that every Filipino is healthy, has access to inexpensive, high-quality
healthcare that is easily available, is shielded from health risks, and a suitable health
care is readily available for them. To guarantee that every Filipino is healthy, is
protected from health risks and dangers, and has access to effective, inexpensive, and
easily accessible healthcare services. Access to preventive, promotional, curative,
rehabilitative, and palliative healthcare services should be available to every Filipino. By
emphasizing primary care near to families and communities, supported by hospitals
that are contracted as part of a network, and making PhilHealth membership
automatic for every Filipino, the UHC Act will enhance and reinforce current health
sector processes and systems. This will eventually result in the development of improved
networks of facilities and providers, thereby ensuring universal access to healthcare. The
government will ensure that the wellbeing and health needs of all Filipinos, especially
those of the vulnerable population, will be addressed.
Through this law, the National Health Insurance Program (NHIP) Membership will expand
access to health services by automatically enrolling all Filipinos in PhilHealth’s (NHIP). It
seeks to ensure that all Filipino citizens have access to a comprehensive set of health
services without financial hardship. The law assures 100 percent population coverage of
PhilHealth—from the 98 percent population coverage in 2018 based on the same year’s
Socioeconomic Report by NEDA. It also ensures the development of the health system’s
human resources through the formulation and implementation of the National Health
Human Resource Master Plan by making sure that all health professionals have
permanent employment and competitive salaries.
With this, poor Filipinos or those who are located in geographically isolated areas will
also be given priority when ensuring access to health services. Furthermore, with
multiple fund sources for PhilHealth, Filipinos will no longer need to troop to various
government offices to secure funds to pay for health expenses. The UHC will also award
grants to medical students and mandate that newly-qualified medics serve for three
years in either a remote area or the public sector.
The UHC Law seeks to re-integrate the Philippines’ highly devolved governance system
into province-wide health systems. These integrated provincial health systems promise
more efficient use of resources and delivery of comprehensive care. Providers are
encouraged to consolidate into health care provider networks, capable of delivering a
range of services, grounded on a strong primary care base. PhilHealth is expanding its
currently limited primary care benefit to a new package called “Konsulta”², with
expanded rates and service inclusions, accessible to all membership types. Health care
provider networks will be contracted by PhilHealth as one entity, aligning their
incentives and accountabilities, and promoting continuity of care.Regrettably, the law
does not mandate this re-integration. Resistance to change, and politics of intervening
laws such as the Local Government Code stand in the way. Municipal mayors stand to
lose authority over their health spending, personnel, and resources, and will only
influence these as a member of the health board. Adequacy and supply-side readiness
of health facilities, as well as financial constraints and the sustainability of PhilHealth are
still prevailing realities.
With the UHC Law, all Filipinos are automatically members of PhilHealth, and are
immediately entitled to benefits. Families and households are also given the freedom to
choose the primary care provider they prefer and trust. Patient involvement in key
decision areas is enhanced through representation in the Health Technology
Assessment Committee that decides on benefit inclusions, and in the provincial health
board that develops and monitors the province health plan.These opportunities for
patients to directly influence matters concerning their own health contribute to a
system that is truly responsive. However, patient knowledge is coming from a rather
weak base. Data shows that for PhilHealth covered indigent families, only 53% knew of
their entitlement for no balance billing, and around 39.6% are misinformed of their
sponsorship. This and other knowledge gaps present real challenges in affording people
genuine participation even in institutionalized processes.
The UHC Law mandates the institutionalization of cooperative intergovernmental
decision-making and implementation, particularly in areas such as health impact
assessment, health professional education, and monitoring and evaluation of health
system performance. The private sector is also enjoined to respond to service delivery
needs as health care provider networks, and to generate evidence together with the
academe through data sharing and commissioning of relevant health policy and
systems studies.Through these more inclusive and regular stakeholder engagement
processes, strategic complementation with partners within and outside government is
encouraged. Still, differences in perspectives and interests are among the greatest
hurdles that affect cooperation and resource allocation. For one, adequacy of
PhilHealth benefit package rates are continuously criticized, particularly by for-profit
private facilities that do not enjoy the government subsidy afforded to public facilities.
Even between government units, changes in processes meant to improve efficiency of
one agency, may result in negative effects for another. When the Department of
Budget and Management (DBM) transitioned to a new budgeting mechanism, it
resulted in a 28% decrease in DOH appropriation from 2018 to 2019.
FINANCING:
Under the UHC Act, Direct Contributors are those who have the capacity to pay
premiums, such as employees, self-earning, professional practitioners, migrant workers,
including their qualified dependents, and lifetime members. They will have to pay
PhilHealth contributions.
All others not mentioned above are considered as Indirect Contributors. They include
indigents identified by the DSWD, beneficiaries of the Conditional Cash Transfer
Program, and those identified in special groups, such as senior citizens, persons with
disabilities, and Sangguniang Kabataan officers. Their monthly payments in PhilHealth
are covered by the national government.
A direct contributor who failed to pay premiums can still avail of PhilHealth. However,
he/she will have to pay missed contributions with an interest compounded monthly. The
interest penalty for employers will not be less than 3%; the interest penalty for
self-earning, professional practitioners and migrant workers will not be less than 1.5%.
Over the next five years, PhilHealth will gradually increase premium rates for direct
contributors, while providing corresponding increases in benefits. Direct contributors will
have to pay the premium according to the following rates:
Province-wide and city-wide health systems will pool and manage the various sources
of funding for health, such as DOH assistance, PhilHealth payments, donations, etc., in a
Special Health Fund (SHF). The SHF can be used to finance both population-based and
individual-based health services, health system operating costs, capital investments
and remuneration of additional health workers and incentives for all health workers
Under the Act, private sector financing agents such as HMOs and private health
insurance will offer complementary (offering benefits that cover services or
diagnostic-groups that PhilHealth is unable to) or supplementary (offering benefits that
pay for shares of the hospital bill that PhilHealth is unable to) benefit packages to
patients.
Here are the fund sources that can be tapped to finance the implementation of the
UHC Act:
a. Increasing revenues from tobacco, alcohol, sugar-sweetened beverages taxes
b. Funds from Philippine Charity Sweepstakes Office (PCSO), Philippine Amusement and
Gaming Corporation (PAGCOR), and Department of Health Medical Assistance
Program (DOH MAP), etc.
c. Annual appropriations of the DOH
d. Proposed increased premium rates and collection efficiency in Philhealth
e. Supplemental funding
SERVICE DELIVERY AND LOCAL HEALTH SYSTEMS:
Under the UHC Act, the government will prioritize investments on health services,
infrastructures, and human resources in hard-to-reach areas. The list of the
hard-to-reach areas will be annually updated as this will become the basis for
preferential licensing of health facilities and contracting of health services.
Section 30 of the UHC Act is about health promotion. The existing Health Promotion and
Communication Service of DOH will be transformed and strengthened into a Health
Promotion Bureau with an adequate budget to improve health literacy and
mainstream health promotion and protection.
The schools under the supervision of the Department of Education (DepEd) shall
formulate programs and modules on health literacy and rights to be integrated into the
existing school curricula. This will intensify the fight against the spread of communicable
diseases and increase in prevalence of non-communicable diseases through the
effective promotion of healthy lifestyle among students, including but not limited to,
physical activity, proper nutrition, and prevention of smoking and alcohol consumption.
Furthermore, the LGUs shall enact stricter ordinances that strengthen and broaden
existing health policies and implement effective programs. This will promote health
literacy and healthy lifestyle among their constituencies to advance population health
and individual wellbeing, reduce the prevalence of non-communicable diseases and
their risk factors, particularly tobacco and alcohol use, lower the incidence of new
infectious diseases, address mental health issues and improve health indicators.
HUMAN RESOURCES FOR HEALTH:
The following mechanisms will ensure that there will be enough human resources in the
different levels of the health sector:
a) National Health Resource Master Plan
b) National Health Workforce Support System
c) Scholarship and Training Program
d) Return Service Agreement
Under the UHC Act, all health professionals and health care workers will be guaranteed
permanent employment and competitive salaries (Chapter VI, Section 23).
REGULATION:
There will be no reductions in the currently implemented benefit packages under
PhilHealth. However, under the UHC Act, the benefit development process will now
undergo Health Technology Assessment to ensure that interventions funded by
Philhealth are cost-effective.
Under the UHC Act, DOH is mandated to prescribe mark-ups on drugs and medical
devices sold in DOH owned healthcare facilities. However, PHIC may also use the
mark-ups prescribed by the DOH for other health facilities it contracts, whether public or
private.
GOVERNANCE:
We always say that an ounce of prevention is better than a pound of cure. In practical
terms, the cost of instituting health promotion and prevention is less than the cost of
paying for treatment and hospitalization. There are several health interventions that can
be done at the level of families and communities, even before the patient contacts the
health system. Health promotion will empower and capacitate Filipinos on how to take
charge of their own health.
With the growing demand for health care and the limited resources, priority setting is
crucial in the health system. Health Technology Assessment (HTA) will serve as the
primary tool in ensuring that health services and goods provided by the government
are cost effective. HTA will cover drugs, vaccines, medical devices, medical
equipment, medical and surgical procedures, preventive, and promotive health
services, traditional medicine and other health-related interventions that are seeking
coverage or funding in the public sectors (Sec. 4n).
Figure 1. Policy Analysis Framework
RECOMMENDATIONS:
One of the biggest prerequisites in this reform process is a shift in governance
paradigms. The UHC reform requires provincial governments to be more accountable
for care of their constituents and management of their health systems. They must
reduce dependence on current national government support on personnel
deployment, commodities, and infrastructure investments. As new policies and
guidelines are formulated, strong communication and promotion interventions must be
pursued by both the national and local governments. Patients need to be informed of
all their entitlements, and the merits of living healthy lifestyles. A clear, strategic,
year-on-year rollout chronology towards achieving the vision for UHC should be laid out
in a transparent manner. Sequencing of reforms should start with generating clear
demand for primary care through patient empowerment and incentive schemes for
providers. By committing to a clear plan of action, the Philippines DOH can build
confidence amongst all stakeholders, public and private, local and national, and
across government. Clarity of vision will be essential to deliver on the promise of UHC in
the Philippines.
REFERENCES:
● Explainer: Universal Health Care Law and what it means to ph development.
National Economic and Development Authority. (2019, June 18). Retrieved
March 6, 2023, from
https://neda.gov.ph/explainer-universal-health-care-law-and-what-it-means-to-p
h-development/
● Sirili, Nathanael. (2018). Health workforce development post-1990s health sector
reforms: the case of medical doctors in Tanzania.
● Tomacruz, S. (2019, April 1). Explainer: What Filipinos can expect from the
Universal Health Care Law. RAPPLER. Retrieved March 6, 2023, from
https://www.rappler.com/newsbreak/iq/226810-explanation-what-filipinos-can-e
xpect-universal-health-care-law/
● Healthcare for all in the Philippines – but is there a catch? ASEAN Today. (2020,
April 19). Retrieved March 6, 2023, from
https://www.aseantoday.com/2019/02/healthcare-for-all-in-the-philippines-but-is
-there-a-catch/
● UNIVERSAL HEALTH CARE ACT FREQUENTLY ASKED QUESTIONS MASTER GUIDE.
Department of Health. (n.d.). Retrieved March 6, 2023, from
https://doh.gov.ph/uhc?fbclid=IwAR0f-RdL0QvznUo67avpyCI__xyesauiH-hfeN-LL
AsLg8O-GJC43gjbSiw
