Universal Health Care Act

Republic Act No. 11223

MARIO C. VILLAVERDE, MD, MPH, MPM, CESO I

Undersecretary of Health | Health Policy and Systems Development Team

Department of Health, Philippines

Declaration of Principles

Integrated and comprehensive Health care model that

approach to ensure health literacy, provides comprehensive
healthy living, and protection from health services without
hazards and risks causing financial hardship

Whole-of-system, whole-of- People-oriented approach

government, whole-of-society centered on people’s needs
approach in the development of and well-being
health policies

Department of Health, Philippines

General Objectives

To progressively realize To ensure equitable access

universal health care to quality and affordable
through systemic approach health care and protection
and clear role delineation against financial risk
of stakeholders

Department of Health, Philippines

UHC Coverage

Population Coverage Service Coverage

Automatic inclusion of Immediate eligibility and
every Filipino citizen access to population-based
into the NHIP and individual-based health
services

Department of Health, Philippines

UHC Coverage
Financial Coverage

Population-based Individual-based
Health Services: Health Services:
• funded by National • funded primarily
Government through pre-payment
through DOH mechanisms (SHI,
• free at point of PHI, HMO)
service

Department of Health, Philippines

National Health Insurance Program

Simplification of NHIP membership:

• Direct contributors – those who Pooling funds to PhilHealth

have the capacity to pay premiums for all individual-based health
• Indirect contributors – those services
whose premiums are subsidized by
the National Government
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Department of Health, Philippines

National Health Insurance Program
 Immediate eligibility

 No co-payment in basic or ward accommodation

 Co-payment/co-insurance for amenities in public

Entitlement to hospitals
Benefits
 No reduction in current PhilHealth package

 Additional benefits for direct contributors

Department of Health, Philippines

National Health Insurance Program
Premium Contributions
Direct contributors Indirect contributors
Year Premium Rate Income Floor Income Ceiling
Gradually adjusted and
2019 2.75 % P10,000.00 P50,000.00 included in the GAA
2020 3.00 % P10,000.00 P60,000.00
2021 3.50 % P10,000.00 P70,000.00
2022 4.00 % P10,000.00 P80,000.00
2023 4.50 % P10,000.00 P90,000.00
2024 5.00 % P10,000.00 P100,000.00
2025 5.00 % P10,000.00 P100,000.00

Department of Health, Philippines

National Health Insurance Program

 Program Reserve Funds

 Administrative Expense
 PhilHealth Board of Directors
 President and Chief Executive Officer
 PhilHealth Personnel as Public Health Workers
 Additional Powers and Functions of PhilHealth

Department of Health, Philippines

Service Delivery
Population-based Health Services
DOH to contract province-wide and city-wide
health systems with the following minimum
components:

Primary care Epidemiologic Health promotion

provider surveillance programs and
network systems campaigns

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Department of Health, Philippines

Service Delivery
Individual-based Health Services
PhilHealth to contract public, private or
mixed health care provider networks that
would agree on:

Co-payment/
Service quality Data submission
co-insurance

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Department of Health, Philippines

Service Delivery
Individual-based Health Services

Incentives for health care Apex or end-referral hospitals

providers that form networks  to be determined by DOH
from DOH and PhilHealth  may be contracted by PhilHealth
as stand-alone providers

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Department of Health, Philippines

 Service Delivery
Individual-based Health Services

A shift to performance-driven, Development of differential Institution of strong

closed-end, prospective payment considering service surveillance and audit
payments based on DRGs, quality mechanisms
validated costing methods, and
no differentiation between facility
and professional fees

13

Department of Health, Philippines

 Organization of Local Health Systems

Integration of health Provincial/City Health Board Municipalities and cities

systems into:  oversee integration of health are entitled to have a
 Province-wide services representative in the
 manage special health fund Provincial/City Health
 City-wide  exercise administrative and Board
technical supervision over
their health facilities and HRH
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Department of Health, Philippines

 Organization of Local Health Systems

Enabling income Income derived from Incentives through financial

retention for all public PhilHealth payments to and non-financial matching
providers through a accrue to the Special Health grants in accordance to local
Special Health Fund Fund and credited as investment plans to improve
Annual Regular Income competitiveness of the Public
(ARI) of the LGU Health Service Delivery System

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Department of Health, Philippines

Human Resources for Health

National Health Human Resources National Health Workforce

Master Plan to provide appropriate Support System to support to
policies and strategies for health local public health systems in
workforce based on population needs, addressing human health needs,
and for permanent employment and especially GIDAs
competitive salaries

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Department of Health, Philippines

 Human Resources for Health
Scholarship and Training Program

Expansion of health Regulation of enrollees Expansion of scholarship

related degree and based on health needs grants for undergraduate
training programs and graduate programs

Setting up of registry of Reorientation of health professional

medical and allied health education, certification and regulation
professionals for provision of primary care services

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Department of Health, Philippines

 Human Resources for Health
Return Service Agreement

Return service for at Provision of additional Establishment of

least three (3) years for incentives for those guidelines for non-
government-funded rendering additional compliance
scholars two (2) years of service

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Department of Health, Philippines

Regulation – Safety and Quality
Establishment of a rating Institutionalization of a
system in PhilHealth licensing and regulatory
under an incentive scheme system in DOH for stand alone
based on service quality, health facilities, ambulatory and
efficiency and equity primary care providers

PhilHealth to recognize DOH to set standards for

third party accreditation clinical care through
mechanism as basis for development and use of
granting incentives clinical practice guidelines

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Department of Health, Philippines

Regulation – Affordability
Procurement of Drugs and Drug outlets to carry generic
Devices of DOH-owned equivalent of all drugs in
Health Care Providers Primary Care Formulary
 follow negotiated prices
 sell in prescribed maximum
mark-ups
 price listing of all drugs/ Mandating transparent pricing
devices procured and sold of health goods and services

Independent Price Negotiation Benefit complementation

Board to negotiate price on between DOH, PhilHealth, PHIs,
behalf of DOH and PhilHealth and HMOs

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Department of Health, Philippines

 Regulation - Equity

Preferential licensing Equitable distribution of Basic accommodation:

of health facilities and health services and benefits • at least 90% for
contracting of health prioritizing GIDA government hospitals
services for • at least 70% for
underserved areas specialty hospitals
• at least 10% for private
hospitals

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Department of Health, Philippines

Governance and Accountability

Creation of a Incorporation of DepEd schools to LGU to enact stricter

Health health promotion be designated as ordinances to promote
Promotion in school curricula healthy settings health literacy and
Bureau in the healthy lifestyle
DOH

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Department of Health, Philippines

Governance and Accountability
Health Impact Assessment as
requirement for all policies,
Evidence-informed Sectoral
programs and projects
Policy and Planning for UHC

Health Technology Assessment

Monitoring and Evaluation
 Establishment of Performance
Monitoring Division
Health Information System

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Department of Health, Philippines

Ethics in Public Health Policy and Practice

 Declaration and management of conflict of interest

 Collection and tracking of financial links of health

care providers to manufacturers of drugs, medical
devices and supplies under FDA

 Public Health Ethics Committee as an advisory

body to the Secretary of Health

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Department of Health, Philippines

Appropriations
Sources of Funding for UHC

 Total incremental sin tax collections

 50% of the National Government share from PAGCOR
 40% of the Charity Fund, net of Documentary Stamp Tax
Payments and mandatory contributions of PCSO
 Premium contributions of members
 Annual appropriations of the DOH
 National Government subsidy to PhilHealth
 Supplemental funding

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Department of Health, Philippines

Penal Provisions

Health care provider of PhilHealth member and

population-based health employer
services

Health care provider of Director, officer or employee

individual-based health of PhilHealth
services

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Department of Health, Philippines

Miscellaneous Provisions

Oversight Provision

 Creation of Joint Congressional Oversight

Committee on UHC
Establishment of Performance
 Validation of UHC accomplishments by Monitoring Division to monitor
NEDA, PSA, NIH and other academic and evaluate the implementation
institutions of UHC
 DOH and PhilHealth to allocate adequate
funding for these studies
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Department of Health, Philippines

Miscellaneous Provisions
President of the Philippines to All affected officers and
appoint new members of the personnel of the PCSO to be
Board and the PCEO of PhilHealth absorbed by the agency without
within thirty (30) days demotion of rank or salary/benefits

All officers and personnel of National Government to provide

PhilHealth, except for members of technical and financial support
the Board, to continuously to LGUs that commit to province-
perform their duties and receive wide integration in the first 6 years
their corresponding salaries and
benefits

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Department of Health, Philippines

Miscellaneous Provisions
Managerial integration of
PhilHealth to outsource certain
province-wide and city-wide
functions to ensure operational
systems within the first 3 years;
efficiency and fulfillment of the Act
financial integration within the
in the first ten (10) years
next 3 years

Integration of all local health Philhealth and DOH to provide

systems through an Executive Order financial and licensing incentives
upon positive recommendation of: to contracted health facilities to form
 independent study commissioned by health care provider networks in the
JCOC first three (3) years
 the Secretary of Health

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Department of Health, Philippines

Miscellaneous Provisions
Within ten (10) years, only those
HTAC under the DOH to be certified by DOH and PRC as
established within one (1) capable of providing primary
year care will be eligible as primary
care provider

PHIs and HMOs, together

with DOH and PhilHealth, to For the first two (2) years, PCSO
develop a system of co- to transfer at least fifty percent
payment that complements (50%) of the forty percent (40%)
PhilHealth benefit packages of the charity fund per year
within three (3) years

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Department of Health, Philippines

Summary - Financing
Clarifying roles: Simplifying
1.DOH and LGU for membership into two
population-based types: direct and indirect
services contributory members
2. PhilHealth for individual-
based services

Pooling funds to Contracting by network

PhilHealth for all based on adherence to
individual-based health quality and co-payment
services (e.g. Sin Tax, standards, and third
PAGCOR, PCSO) party accreditation

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Department of Health, Philippines

 Summary - Service Delivery

Consolidating fragmented Institutionalizing primary care Enabling income

providers into province- provider networks, retention for all public
wide and city-wide service epidemiologic surveillance providers through a
delivery networks to systems and health Special Health Fund
navigate and coordinate promotion as minimum
components of population-
based health services
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Department of Health, Philippines

Summary - Regulation
Ensuring benefit
complementation between
Mandating transparent
PhilHealth and Private Health
pricing of health goods Insurance (PHIs) and Health
and services Maintenance Organizations
(HMOs)

Basic and non-basic Expanding scholarship programs,

accommodation bed requiring 3 years return service
ratio of 90:10 for in underserved areas for
government hospitals, government scholars,
augmenting HRH through
70:30 for specialty national health workforce
hospitals, and 10:90 for support system, primary care-
private hospitals oriented education, health
professionals registry
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Department of Health, Philippines

Summary - Governance
Institutionalizing Health
Requiring submission of Technology Assessment as
health and financial data prerequisite for public financing
by health care providers of goods and services, and
and suppliers harmonized Health Impact Assessment
to an interoperable system; for various programs, policies,
sharing of publicly- and projects
funded data sets

Streamlining PhilHealth
Strengthening medicines
Board from 17 to 13
procurement, price
members
negotiation and
affordability

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Department of Health, Philippines

Presentation can be accessed at:
bit.ly/RA11223