UHC

additional powers and functions of philhealth

To adopt or approve the annual and supplemental budget of receipts and expenditures including salaries, allowances and early retirement of PhilHealth personnel and to authorize such capital and operating expenditures and disbursements as may be necessary and proper for the effective management and operation of PhilHealth

additional powers and functions of philhealth

To establish the organizational structure and staffing pattern of PhilHealth's central and regional offices to cover as many provinces, cities and legislative districts, including foreign countries, whenever and wherever it may be expedient, necessary and feasible and to inspect or cause to be inspected periodically such offices, subject to the approval by the Board;

additional powers and functions of philhealth

To fix the reasonable compensation, allowances and other benefits of all positions, including its President and CEO, based on a comprehensive job analysis and audit of actual duties and responsibilities, subject to the approval of the President of the Philippines.

Republic Act. No 11223

Universal Health Care Act

what filipinos can expect from the universal health care law?

all filipinos will be granted health coverage but not everything will be free

UHC Population coverage

every filipino citezen shall be automatically included unto the National Health Insurance Program (NHIP)

population-based health services

Province-wide and city-wide health systems shall have the minimum components -- primary care provider network with patient records accessible throughout the health system -- accurate, sensitive, and timely epidemiologic surveillance systems -- proactive and effective health promotion programs or campaigns

Universal Health Care Act

A framework that fosters a whole-of-system, whole-of-government, and whole-ofsociety approach in the development, implementation, monitoring, and evaluation of health policies, programs and plans

Universal Health Care Act

A health care model that provides all Filipinos access to a comprehensive set of quality and cost-effective, promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardship,, and prioritizes the needs of the population who cannot afford such services

ex officio members

- Secretary of Health - Secretary of Social Welfare and Development - Secretary of Finance -Secretary of Labor and Employment

universal health care law

- all Filipinos are covered - it is not completely free - PhilHealth will become the "national purchaser" of health goods and services - DOH will still be in charge of "population-based" health services - health systems will become city-wide and province-wide - A "Health Technology and Assessment Council" (HTAC) will be created - health information will be collected

expert panel members must

- be of recognized probity and independence and must have distinguished themselves professionally in public, civic or academic service - be in the active practice of their professions for at least seven years - not be appointed within one year after losing in the immediately preceding elections, whether regular or special

clarified roles under the universal health care law

- department of health and local government units - philhealth

General objectives of UHC

- ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk

policy issue 1

- limited coverage of the national health insurance program --- in 2017, about 54.5% of total health payment came from Filipinos' own pocket, with medicines and drugs as the main contributors. Lack of PhilHealth coverage of medicines for outpatients and the high cost of drugs and medicines in the country push the out-of-pocket expenditure up.

expert panel members with expertise in public health

- management - finance - health economics

policy issue 2

- overlapping of functions of govt agencies --- the Philippine health system has been operating on a devolved set-up. The Department of Health supervises specialty, DOH-retained, and regional hospitals. The Department of National Defense runs military hospitals. And local government units operate their respective health facilities.

health services delivery

- population-based health services - individual-based health services

General objectives of UHC

- progressively realize universal health care in the country through a systemic approach and clear delineation of roles of key agencies and stakeholders towards better performance in the health system

sectoral panel members

- representing the direct contributors, indirect contributors, employers group, health care providers to be endorsed by their national associations of health care institutions and health care professionals, and representative of the elected local chief executives to be endorsed by the League of Provinces of the Philippines, League of Cities of the Philippines and League of Municipalities of the Philippines: provided that at least one of the expert panel members and at least two of the sectoral panel members are women

Service coverage

Every Filipino shall be granted immediate eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental and emergency health services, delivered either as population-based or individual-based health services: Provided, That the goods and services to be included shall be determined through a fair and transparent HTA process;

Service coverage

Every Filipino shall register with a public or private primary care provider of choice. The DOH shall promulgate the guidelines on the licensing of primary care providers and the registration of every Filipino to a primary care provider.

Universal Health Care Act

A people-oriented approach for the delivery of health services that is centered on people's needs and well-being, and cognizant of the differences in culture, values, and beliefs

Universal Health Care Act

An integrated and comprehensive approach to ensure that all Filipinos are health literate, provided with healthy living conditions, and protected from hazards and risks that could affect their health

Socioeconomic Planning Secretary

Ernesto M. Pernia

individual-based health services

PhilHealth shall endeavor to contract public, private, or mixed health care provider networks for the delivery of individual-based health services:

individual-based health services

PhilHealth shall endeavor to shift to paying providers using performance-driven, close-end, prospective payments based on disease or diagnosis related groupings and validated costing methodologies and without differentiating facility and professional fees;

Service coverage

The DOH and the local government units (LGUs) shall endeavor to provide a health care delivery system that will afford every Filipino a primary care provider that would act as the navigator, coordinator, and initial and continuing point of contact in the health care delivery system: Provided, That except in emergency or serious cases and when proximity is a concern, access to higher levels of care shall be coordinated by the primary care provider;

Service coverage

Within two (2) years from the effectivity of this Act, PhilHealth shall implement a comprehensive outpatient benefit, including outpatient drug benefit and emergency medical services in accordance with the recommendations of the Health Technology Assessment Council (HTAC) created under Section 34 hereof;

Financial coverage

individual-based health services shall be financed primarily through prepayment mechanisms such as social health insurance, private health insurance, and HMO plans to ensure predictability of health expenditures

ex officio

is Latin, meaning literally 'from the office', and the sense intended is 'by right of office'

ex officio member

is a member of a body (notably a board, committee, council) who is part of it by virtue of holding another office

Universal Health Care Act

it is the policy of the state to protect and promote the right to health of all Filipinos and instill health consciousness among them

Program membership

membership into the program shall be simplified into two types -direct contributors -indirect contributors

administrative expense

no more than 7.5% of the actual total premium collected from direct and indirect contributory members during the immediately preceding year shall be allotted for the administrative cost of implementing the program

UHCL by NEDA

policy issue 1: limited coverage of the national health insurance program 2: overlapping of functions of govt agencies

Financial coverage

population-based health services shall be financed by the National Government through the DOH and provided free of charge at point of service for all Filipinos

philhealth board of directors

reconstituted to have a maximumof thirteen members -- 5 ex officio members -- 3 expert panel members with expertise in publich health -- 5 sectoral panel members --

indirect contributors

refer to all others not included as direct contributors, as well as their qualified dependents, whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws

direct contributors

refer to those who have the capacity to pay premiums, are gainfully employed and are bound by an employer-employee relationship or are self-earning, professional practioners, migrant workers, including their qualified dependents, and lifetime members

population based health services

refers to interventions, such as health promotion, disease surveillance, and vector control, that address population-wide concerns.

individual based health services

refers to services that can be accessed within a health facility or remotely, and can be definitively traced back to one recipient

secretary of health

shall be an ex officio nonvoting Chairperson of the Board

appointive members of the Board

shall be required to undergo training in health care financing, health systems, costing health services and Health Technology Assessment prior to the start of their term. Noncompliance shall be a ground for dismissal

population-based health services

the DOH shall endeavor to contract province-wide and city-wide health systems for the delivery of population-based health services.

additional powers and functions of philhealth

to maintain a Provident Fund which consists of contributions made by both PhilHealth and its officials and employees and earnings thereon, for the payment of benefits to such officials and employees or their dependents or heirs under such terms and conditions as may be prescribed by the Board, subject to the approval of the President of the Philippines