RA 11223

Abuse of Authority

Refers to an act of a person performing a duty or function that goes beyond what is authorized by this Act and Republic Act No. 7875, otherwise known as the "National Health Insurance Act of 1995", as amended, or their implementing rules and regulations (IRR), and is inimical to the public

Health Maintenance Organization (HMO)

Refers to an entity that provides, offers, or covers designated health services for its plan holders or members for a fixed prepaid premium

Fraudulent Act

Refers to any act of misrepresentation or deception resulting in undue benefit or advantage on the part of the doer or any means that deviate from normal procedure and is undertaken for personal gam, resulting thereafter to damage and prejudice which may be capable of pecuniary estimation

Unethical Act

Refers to any action, scheme or ploy against the NHIP, such as overbilling, upcasing, harboring ghost patients or recruitment practice, or any act contrary to the Code of Ethics of the responsible persons profession or practice, or other similar, analogous acts that put or tend to put in disrepute the integrity and effective implementation of the NHIP

Entitlement

Refers to any singular or package of health services provided to Filipinos for the purpose of improving health

Private Health Insurance

Refers to coverage of a defined set of health services financed through private payments in the form of a premium to the insurer

Primary Care

Refers to initial-contact, accessible, continuous, comprehensive and coordinated care that is accessible at the time of need including a range of services for all presenting conditions, and the ability to coordinate referrals to other health care providers in the health care delivery system, when necessary

Basic or Ward Accomodation

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

Health Technology Assessment (HTA)

Refers to the systematic evaluation of properties, effects, or impact of health-related technologies, devices, medicines, vaccines, procedures and all other health-related systems developed to solve a health problem and improve quality of lives and health outcomes, utilizing a multidisciplinary process to evaluate the social, economic, organizational, and ethical issues of a health intervention or health technology;

(1) Filipino (2) Good Moral Character (3) Be of recognized probity and independence and must have distinguished themselves professionally in public, civic or academic service (4) Be in the active practice of their professions for at least 7 years (5) Not be appointed within 1 year after losing in the immediately preceding elections

Requirements for Expert Panel Members

(1) Filipino (2) Have 7 years of experience in the field of public health, management, finance, and health economics

Requirements for President of CEO of PhilHealth

(1) Filipino (2) Good Moral Character

Requirements for Sectoral Panel Members

(a) 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 (b) PhilHealth: Comprehensive outpatient benefit, including outpatient drug benefit and emergency medical services (c) DOH and LGU: health care delivery system that will afford every Filipino a primary care provider (d) Every Filipino shall register with a public or private primary care provider of choice

Service Coverage (a-d)

Direct Contributors and Indirect Contributors

Types of Program Membership

Every Filipino

Population Coverage: _____________________ shall be automatically included into the NHIP

Co-Insurance

Refers to a percentage of a medical charge that is paid by the insured, with the rest paid by the health insurance plan

Essential Health Benefit Package

Refers to a set of individual-based entitlements covered by the National Health Insurance Program (NHIP) which includes primary care; medicines, diagnostics and laboratory; and preventive, curative, and rehabilitative services

Primary Care Provider

Refers to a health care worker, with defined competencies, who has received certification in primary care as determined by the Department of Health (DOH) or any health institution that is licensed and certified by the DOH

February 21, 2019

Date when RA 11223 was passed

Secretary of Health

Ex officio non-voting Chairperson of the PhilHealth Board

(a) 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; (b) 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; (c) A framework that fosters a whole-of-system, whole-of-government, and whole-of-society approach in the development, implementation, monitoring, and evaluation of health policies, programs and plans; and (d) 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.

Declaration of Principles and Policies: the State shall adopt (a-d)

All graduates of allied and health-related courses who are recipients of government-funded scholarship programs shall be required to serve in priority areas in the public sector for at least three (3) full years, with compensation, and under the supervision of the DOH: Those who will serve for additional two (2) years shall be provided with additional incentives as determined by the DOH

Describe the RSA

(1) Universal Health Care (2) Ensure equitable access to quality and affordable health care goods and services

General Objectives (2)

(1) Health facility (2) Health care professional (3) Community-based health care organization (4) Pharmacies or drug outlets, laboratories and diagnostic clinics.

Health care provider refers to any of the following (4)

Appointed by the President of the Philippines upon the recommendation of the Board

How is the President of CEO of PhilHealth chosen?

(1) Right to Health (2) Health Consciousness

It is the policy of the State to protect and promote the (1) of all Filipinos and instill (2)

Total of 13 Members 5 Ex Officio Members *Secretary of Health *Secretary of Social Welfare and Development *Secretary of Budget and Management *Secretary of Finance *Secretary of Labor and Employment 3 Expert Panel Members (at least 1 should be female) *Have expertise in public health, management, finance, and health economics 5 Sector Panel Members (at least 2 should be female) *Represents direct contributors, indirect contributors, employers group, health care providers NOTE: all appointive members of the Board shall be required to undergo training in health care financing, health systems, costing health services and HTA prior to the start of their term

Members of the PhilHealth Board of Directors

The Universal Health Care act of 2019

Other name for RA 11223

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

Amenities

Refer to features of the health service that provide comfort or convenience, such as private accommodation, air conditioning, telephone, television, and choice of meals, among others

Population-Based Health Services

Refer to interventions such as health promotion, disease surveillance, and vector control, which have population groups as recipients

Individual-Based Health Services

Refer to services which can be accessed within a health facility or remotely that can be definitively traced back to one (1) recipient, has limited effect at a population level and does not alter the underlying cause of illness such as ambulatory and inpatient care, medicines, laboratory tests and procedures, among others

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 practitioners, migrant workers, including their qualified dependents, and lifetime members

Emergency

Refers to a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty, there is immediate danger and where delay in initial support and treatment may cause loss of life or permanent disability to the patient, or in the case of a pregnant woman, permanent injury or loss of her unborn child, or a non-institutional delivery

Co-Payment

Refers to a flat fee or predetermined rate paid at point of service

Health Care Provider Network

Refers to a group of primary to tertiary care providers, whether public or private, offering people-centered and comprehensive care in an integrated and coordinated manner with the primary care provider acting as the navigator and coordinator of health care within the network