Key Features of The Uhc Act (Marked As Final)

Universal Health Care Act
Republic Act No. 11223
UHC Implementing Rules and Regulations

Department of Health, Philippines
Declaration of Principles
• Integrated and comprehensive approach to
ensure health literacy, healthy living, and protection
from hazards and risks
• Health care model that provides comprehensive
health services without causing financial
hardship
• Whole-of-system, whole-of-government,
whole-of-society approach in the development of
health policies
• People-oriented
UHC Implementing Rules and approach
Regulations centered on people’s
needs and well-being
General Objectives
• To progressively realize universal health care

through systemic approach and clear role
delineation of stakeholders
• To ensure equitable access to quality and
affordable health care and protection against
financial risk

Chapter II. Universal Health Care
Population Coverage – automatic inclusion of
every Filipino citizen into the NHIP
Service Coverage
• immediate eligibility and access to population-
based and individual-based health services
• comprehensive outpatient benefit package
• provision of primary care provider

Chapter II. Universal Health Care
Financial Coverage
Population-based health services
• funded by National Government through DOH
• free at point of service
Individual-based health services
• primarily through pre-payment mechanisms
(SHI, PHI, HMO)

Chapter III. National Health Insurance
Program
Membership
• Direct contributors – those who have the
capacity to pay premiums
• Indirect contributors – those whose premiums
are subsidized by the national government

Program
Entitlement to Benefits
• immediate eligibility
• no co-payment in basic or ward accommodation
• co-payment and co-insurance for amenities in
public hospitals regulated by DOH and PhilHealth
• no reduction in current PhilHealth package
• additional benefits for direct contributors, where
applicable
Program
Premium Contributions
For direct contributors
Year Premium Rate Income Floor Income Ceiling
2019 2.75 % P10,000.00 P50,000.00
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
ForUHC
indirect contributors
Implementing – to be gradually adjusted and included
Rules and Regulations
in the GAA of Health, Philippines
Department
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

Chapter IV: Health Services Delivery
Population-based Health Services
• DOH to contract province-wide and city-wide
health systems
• Minimum components:
• primary care provider network
• epidemiologic surveillance systems
• health promotion programs/campaigns

Individual-based Health Services
• Philhealth to contract public, private or mixed
health care provider networks
• service quality
• co-payment/co-insurance
• data submission
• PhilHealth and DOH to incentivize health care
providers that form networks

Individual-based Health Services
• DOH to determine apex or end-referral hospitals; may
be contracted by PhilHealth as stand-alone providers
• PhilHealth to:
• shift to performance-driven, closed-end, prospective
payments based on DRGs, validated costing
methods, and no differentiation between facility and
professional fees
• develop differential payment considering service
quality
•UHC
institute strong
Implementing surveillance
Rules and Regulations and audit mechanisms
Chapter V: Organization of Local Health
Systems
Integration into Province-wide and City-wide
Health Systems
• Provincial/City Health Board to:
• oversee integration of health services
• manage the special health fund
• exercise administrative and technical supervision
over health facilities and HRH within their
jurisdiction
• Municipalities and cities to be represented in the
Board
Systems
Special Health Fund
• Province-wide and City-wide Health System shall
pool and manage all resources in order to finance
population-based and individual-based health
services
• DOH, in consultation with DBM and LGUs, shall
develop guidelines for Special Health Fund

Systems
Income derived from PhilHealth payments
• PhilHealth payments shall accrue to the Special Health
Fund and credited as Annual Regular Income (ARI) of
the LGU
Incentives for improving competitiveness of

the Public Health Service Delivery System
• National Government to provide financial and non-
financial matching grants in accordance with province-
wide and city-wide investment plans
Chapter VI: Human Resources for Health
National Health Human Resources Master Plan
• Provision of policies and strategies for appropriate
health workforce based on population needs, and for
guaranteed permanent employment and competitive
salaries
National Health Workforce (NHW) Support

System
• Support to local public health systems in addressing
human health needs, especially for GIDAs
Scholarship and Training Program
• expansion of existing and new health related degree
and training programs
• regulation of the number of enrollees based on health
needs
• expansion of scholarship grants for undergraduate and
graduate programs
• setting-up of registry of medical and allied health
professionals
• reorientation of health professional education,
certification
UHC Implementingand regulation
Rules and Regulations towards provision of
primary care services
Return Service Agreement
• return service for at least three (3) years for recipients
of government-funded scholarship programs
• provision of additional incentives for those rendering
additional two (2) years of service
• establishment of guidelines for non-compliance

Chapter VII: Regulation
Safety and Quality
PhilHealth to:
• establish a rating system under an incentive
scheme based on service quality, efficiency and
equity
• recognize third party accreditation mechanism

Safety and Quality
DOH to:
• institute a licensing and regulatory system for
stand-alone health facilities, ambulatory and
primary care providers
• set standards for clinical care through
development and use of clinical practice
guidelines

Affordability
• Procurement of Drugs and Devices of DOH-owned
Health Care Providers
• follow centrally negotiated prices
• sell in prescribed maximum mark-ups
• submit a price list of all drugs/devices procured and
sold
• Independent Price Negotiation Board
• negotiate prices on behalf of DOH and PhilHealth
Affordability
• health care providers to make price information
of health goods and services readily accessible
• drug outlets to carry the generic equivalent of all
drugs in the Primary Care Formulary
• DOH, PhilHealth, HMOs and PHIs to develop
policies and plans for complementation of health
benefits

Equity
• preferential licensing of health facilities and
contracting of health services for underserved areas
• equitable distribution of health services and benefits
prioritizing GIDA
• all government hospitals to operate not less than 90%
of bed capacity as basic accommodation; specialty
hospitals not less than 70%; private hospitals not less
than 10%

Chapter VIII: Governance and
Accountability
Health Promotion
Transformation of HPCS to Health Promotion Bureau
• formulation of strategy for increasing health literacy
• implementation of health promotion programs and
activities across social determinants of health
• policy coordination across government
instrumentalities
• provision of technical support to local research and
development
Accountability
Health Promotion
• at least one percent (1%) of total DOH budget
earmarked for health promotion programs
• DepEd schools to be designated as healthy
settings
• incorporation of health promotion in school
curricula
• LGU to enact stricter ordinances to promote
health literacy and healthy lifestyle
Accountability
Evidence-Informed Sectoral Policy and Planning for
UHC
• all health-related entities to submit health data to
PhilHealth
• DOH and DOST to develop cadre of policy systems
researchers, experts and managers through training
grants
• administrative and survey data generated using public
funds considered as public records and made
accessible to the public
• action
researches on health promotion and social
Accountability
Monitoring and Evaluation

• PSA to conduct relevant modules of household surveys
annually for the first ten (10) years of implementation
• DOH to publish annual provincial burden of disease
estimates
Health Impact Assessment

• HIA as requirement for all policies, programs and
projects

Accountability
Health Technology Assessment
• institutionalization of HTA process to inform
policies and decisions of DOH and PhilHealth
• creation of HTAC within DOH
• within five (5) years after establishment, HTAC to
be an independent entity separate from DOH,
attached to DOST

Accountability
Ethics in Public Health Policy and Practice
• declaration and management of conflict of
interest
• collection and tracking of financial relationships
with health care professionals/providers for all
manufacturers of drugs, medical devices, and
medical supplies registered by FDA
• Public health ethics committee as an advisory
body to the Secretary of Health
Accountability
Health Information System
• health service providers and insurers to maintain
a health information system to be electronically
uploaded on a regular basis through interoperable
system
• enterprise resource planning
• human resource information
• electronic health records
• electronic prescription log
Chapter IX: Appropriations
Source 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

Chapter X: Penal Provisions
Penalties and sanctions cover the following:
• health care provider of population-based health
services
• health care provider of individual-based health
services
• PhilHealth member
• employer
• Director, officer or employee of PhilHealth

Chapter XI: Miscellaneous Provisions
Oversight Provision
• Creation of Joint Congressional Oversight
Committee on UHC
• NEDA, PSA, NIH and other academic institution to
validate and evaluate UHC accomplishments
• DOH and PhilHealth to allocate adequate funding
for these studies

Performance Monitoring Division
• Establishment of Performance Monitoring Division
to monitor and evaluate the implementation of
UHC
• Office-in-charge of field implementation
performance to comprise the core personnel of
the office

Transitory Provision
• President of the Philippines to appoint new members
of the Board and the PCEO of PhilHealth within thirty
(30) days
• All officers and personnel of PhilHealth, except for the
members of the Board, to continuously perform their
duties and receive their corresponding salaries and
benefits
• All affected officers and personnel of the PCSO to be
absorbed by the agency without demotion of rank or
salary/benefits
• National Government to provide technical and financial
support to LGUs that commit to province-wide
integration in the first 6 years
• managerial integration of province-wide and city-wide
systems within the first 3 years; financial integration
within the next 3 years
• upon positive recommendation by an independent
study and by the Secretary of Health all local health
systems shall be integrated through issuance of an
E.O. by the President
• PhilHealth to outsource certain functions to ensure
operational efficiency and fulfillment of the Act in
the first ten (10) years
• Philhealth and DOH to provide reasonable financial
and licensing incentives to contracted health
facilities to form health care provider networks in
the first three (3) years

• HTAC under the DOH to be established within one (1) year
• PHIs and HMOs, together with DOH and PhilHealth, to
develop a system of co-payment that complements
PhilHealth benefit packages within three (3) years
• Within ten (10) years, only those certified by DOH and
PRC as capable of providing primary care will be eligible
as primary care provider
• For the first two (2) years, PCSO to transfer at least fifty
percent (50%) of the forty percent (40%) of the charity
fund per year
Summary - Financing
Clarifying roles: Simplifying
1.DOH and LGU for membership into
population-based two types: direct and
services indirect contributory
2. PhilHealth for members
individual-based
services
Pooling funds to Contracting by
PhilHealth for all network based on
individual-based adherence to quality
health services (e.g. and co-payment
Sin Tax, PAGCOR, standards, and third
PCSO) party accreditation
39

Summary - Service Delivery
Consolidating fragmented Institutionalizing primary Enabling income

providers into province- care provider networks, retention for all public
wide and city-wide epidemiologic providers through a
service delivery surveillance systems and Special Health Fund
networks to navigate and health promotion as
coordinate minimum components of
population-based health
40
services
Summary - Regulation
Mandating Ensuring benefit
transparent pricing of complementation between
health goods and PhilHealth and Private Health
services Insurance (PHIs) and Health
Maintenance Organizations
(HMOs)
Basic and non-basic Expanding scholarship
accommodation bed programs, requiring 3 years
ratio of 90:10 for return service in
government hospitals, underserved areas for
70:30 for specialty government scholars,
augmenting HRH through
hospitals, and 10:90 for national health workforce
private hospitals support system, primary
care-oriented education,
health professionals registry
41

Summary - Governance
Requiring submission of Institutionalizing Health
health and financial Technology Assessment
data by health care as prerequisite for public
providers and suppliers financing of goods and
harmonized to an services, and Health
interoperable system; Impact Assessment for
sharing of publicly- various programs, policies,
funded data sets and projects
Strengthening Streamlining
medicines PhilHealth Board
procurement, price from 17 to 13
negotiation and members
affordability
42

Maraming salamat po!

Key Features of The Uhc Act (Marked As Final)

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Universal Health Care Act

Republic Act No. 11223

UHC Implementing Rules and Regulations

• To progressively realize universal health care

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

Incentives for improving competitiveness of

National Health Workforce (NHW) Support

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

Monitoring and Evaluation

Health Impact Assessment

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

Consolidating fragmented Institutionalizing primary Enabling income

UHC Implementing Rules and Regulations

UHC Implementing Rules and Regulations

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