MTLBE - RA 11223

1. Allocating funding and scaling up Health Promotion initiatives 2. Mandating Health Impact Assessment for all programs, policies, and projects 3. Mandatory use of IT systems and submission of health and financial data by health care providers and suppliers 4. Promoting fairness and transparency in benefits expansion through Health Technology Assessment

Systemic approach to governance (4)

1. Transparent pricing of health goods and services 2. Basic and non-basic accommodation bed ratio 3. Benefit complementation between PHIs and HMOs 4. Licensing for stand-alone health facilities, ambulatory and PCP 5. Registry for health care providers

Systemic approach to regulation (5)

True

T/F: The Provincial / City Health Board also represents the municipalities

Amenities

Refers to features of the health services provide comfort or convenience such as private accommodation, air conditioning, telephone, and choice of meals, among others

Basic accommodation

Refers to the provision of regular meal, bed in shared room, fan ventilation, and shared toilet and bath

1. Oversee integration of health services 2. Manage the special health fund 3. Exercise administrative and technical supervision over health facilities and human resource within their jurisdiction

Responsibilities of the Provincial / City Health Board (3)

At least 3 years

Return service agreement for recipients of government-funded scholarship program

1. Expansion of existing and new health related degree and training programs 2. Regulation of the number of enrollees based on needs 4. Expansion of scholarship grants 5. Reorientation of health professional education, certification and regulation towards provision of primary care services

Scholarship & training program (READ)

Declaration of Principles & Policies

Section 2 of RA 11223

General Objectives

Section 3 of RA 11223

1. Immediate eligibility and access 2. Comprehensive outpatient benefit 3. Provision of primary care

Service coverage of RA 11223 (3)

1. Sin tax 2. PAGCOR 3. PCSO

Source of funds for individual-based health services (3)

1. Eliminating redundancies 2. Pooling of funda to PhilHealth 3. Simplifying membership 4. Improving current provider payment mechanisms

Systemic approach in financing (4)

1. Contracting by network 2. Public system -> province-wide and city-wide health system 3. Special health fund 4. Improving pool, presence, perspective of HCW

Systemic approach in service delivery (4)

Universal Health Care Act

Title of RA 11223

1. Shift to performance driven, close end, prospective payments based of DRGs, validated costing methods and no differentiation between facility and professional fees 2. Develop differential payment considering service quality

To improve current provider payment mechanisms PhilHealth shall... (READ)

Executive Order

Upon positive recommendation by an independent study and by the Secretary of Health: all local health systems shall be integrated through an issuance of an _________ by the President

DOH, LGU

Population-based health services are financed by?

1. Integrated and comprehensive approach 2. Whole of system, whole of government, whole of society approach 3. People-oriented approach

Principles of RA 11223 (3)

1. Direct contributors 2. Indirect contributors

2 types of NHIP membership

Population coverage

Automatic inclusion of every Filipino citizen in the NHIP

90:10

Basic and non-basic accommodation bed ratio for government

70:30

Basic and non-basic accommodation bed ratio for government specialty

10:90

Basic and non-basic accommodation bed ratio for private hospitals

National Health Workforce (NHW) Support

Created to support local public health systems in addressing human health needs especially for GIDAs

Primary care provider

DOH and the LGUs shall endeavor to provide a health care delivery system that will afford every Filipino a _________--- that would act as the navigator, coordinator, and initial and continuing point of contact in the health care delivery system

DBM; LGUs

DOH, in consultation with _______ and ________, shall develop guidelines for Special Health Fund

Province-wide & city-wide health systems

Delivery of population-based health services is through?

1. Zero co-payment 2. Fixed, predictable payment

Financial coverage of RA 11223 (2)

Health Promotion Bureau

For health promotion, HPCS is transformed to _____________

At least 1%

For health promotion, ___________% of total DOH budget earmarked for health promotion program

1. To ensure equitable access to quality and affordable healthcare and protection against financial risk 2. To progressively realize universal health care through systemic approach and clear role delineation

General Objectives of RA 11223

1. Enterprise resource planning 2. Human resource information 3. Electronic health records 4. Electronic prescription log

Health information system for... (READ)

Health information system

Health service providers and insurers to maintain a _____________ to be electronically uploaded on a regular basis through interoperable system

PHIC

Individual-based health services are financed by?

6 First 3 years: managerial integration of province-wide and city-wide systems Next 3 years: financial integration

National Government to provide technical and financial support to LGUs that commit the province wide integration in the first _________ years

1. DepEd schools to be designated as healthy settings 2. incorporation of health promotion in school curricula 3. LGU to enact stricter ordinances to promote health literacy and healthy lifestyle

Other Health promotion initiatives (READ)

Networks

PhilHealth and DOH to incentivize health care providers that form ____________

Special Health Fund

PhilHealth payments shall accrue to the ___________ and credited as Annual Regular Income (ARI) of the LGU

1. Service quality 2. Co-payment / co-insurance 3. Data submission

PhilHealth to contract public, private or mixed health care provider networks based on...

Special health fund

The province-wide or city-wide health system shall pool and manage, through a ____________ the ff: 1. Resources intended for health services to finance population-based and individual-based health services 2. Health system operating costs 3. Capital investments 4. Remuneration of additional health workers 4. Incentives for all health worker