Universal health care act (RA 11223)
1.) Procurement of drugs and devices of DOH-owned Health Care Providers 2.) Independent Price negotiation board 3.) Drug outlets to carry generic equivalent of all drugs 4.) Mandating transparent pricing of health goods and services 5.) Benefit complementation between DOH, PhilHealth, PHIs, and HMOs
Regulation-Affordability
1.) preferential licensing of health facilities and contracting of health services for underserved areas 2.) equitable distribution of health services and benefits prioritizing GIDA 3.) Basic accommodation (>90% for govt. hospitals, >70% for specialty hospitals, >10% for private hospitals)
Regulation-equity
1.) Population-based health services 2.) Individual-based health services
Service delivery
service quality co-payment/co-insurance data submission
What are the individual-based health services under service delivery?
Primary care provider network (medical professionals, ) Epidemiologic surveillance systems Health promotion programs and campaigns
What are the population-based health services under service delivery?
population coverage service coverage financial coverage
What are the three UHC coverage?
General Appropriations Act
What does GAA stands for?
National Health Insurance Program
What does NHIP stands for?
declaration of principles
aiming for all Filipinos will be automatically members of PhilHealth and receive all benefits; to avoid medical financial problem.
population coverage
automatic inclusion of every Filipino citizen into the NHIP
pooling of funds to philphealth
for all individual-based health services
Individual-based health services
funded primarily through pre-payment mechanism - e.g., Social health insurance (SHI), PhilHealth insurance (PHI), Health Maintenance Organization (HMO)
1. To PROGRESSIVELY (hinay-hinay ang pag effect sa parts under this law) realize universal health care through systemic approach and clear role delineation of stakeholders 2. To ensure EQUITABLE access to quality and affordable health care and protection against financial risk
general objectives
national health workforce support system
this is to support local public health systems in addressing human health needs, especially GIDAs
direct contributors
those who have the capacity to pay premiums (self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members)
indirect contributors
those whose premiums are subsidized by the National Government (DSWD, PWD, filipinos above 21 yo that has no capacity to pay premium)
population-based health services
- funded by National Government (DOH) - free at point of services - e.g., vaccinations, immunizations
Two hundred thousand pesos (₱200,000.00), suspension, three (3) months, PhilHealth
A health care provider contracted for the provision of individual-based health services who commits an unethical act, abuses the authority vested upon the health care provider, or performs a fraudulent act shall be punished by a fine of _____________ for each count, or ______ of contract up to _______ or the remaining period of its contract or accreditation whichever is shorter, or both, at the discretion of the ________, taking into consideration the gravity of the offense
Fifty thousand pesos (₱50,000.00), 3-6 months
A member who commits any violation of this Act or knowingly and deliberately cooperates or agrees, whether explicitly or implicitly, to the commission of a violation by a contracted health care provider or employer as defined in this section, including the filing of a fraudulent claim for benefits or entitlement under this Act, shall be punished by a fine of ________ for each count or suspension from availment of the benefits of the Program for _________ , or both, at the discretion of PhilHealth
Two hundred thousand pesos (₱200,000.00), suspension for three months without pay, or both, six (6) months and one (1) day up to six (6) years
Any director, office or employee of PhilHealth who commits an unethical act, abuse of authority, or performs a fraudulent act shall be punished by a fine of ________ or _________ or _______ at the discretion of PhilHealth, taking into consideration the gravity of the offense. The same shall also constitute a criminal violation punishable by imprisonment for __________, upon discretion of the court without prejudice to criminal liability defined under the Revised Penal Code
misappropriation of funds, triple the amount misappropriated per count and suspension for three (3) months without pay
Any director, officer or employee of PhilHealth who without prior authority or contrary to the provisions of this Act or its IRR, wrongfully receives or keeps funds or property payable or deliverable to the PhilHealth, and who appropriates and applies such fund or property for personal use, or shall willingly or negligently consents either expressly or implicitly to the misappropriation of funds or property without objecting to the same and promptly reporting the. matter to proper authority, shall be liable for _______ under this Act and shall be punished with a fine equivalent to ____________.
thirty (30) days, prima facie,
Any employer or any officer authorized to collect contributions under this Act who, after collecting or deducting the monthly contributions from the employee's compensation, fails or refuses for whatever reason to accurately and timely remit the contributions to PhilHealth within _______ from due date shall be presumed ______ to have misappropriated the same and is obligated to hold the same in trust for and in behalf of the employees and PhilHealth, and is immediately obligated to return or remit the amount
Fifty thousand pesos (₱50,000.00), 6 months to 1 year
Any employer who deliberately or through inexcusable negligence, fails or refuses to register employees regardless of their employment status, accurately and timely deduct contributions from the employee's compensation or to accurately and timely remit or submit the report of the same to PhilHealth shall be punished with a fine of _________ for every violation per affected employee, or imprisonment of ________, or both such fine and imprisonment, at the discretion of the court.
Sources of funding for UHC 1.) total incremential sin tax collections (products that are harmful and undersirable) 2.) 50% of National Government share from PAGCOR (PCSO, casinos) 3.) 40% of the Charity Fund, net of Documentary Stamp Tax Payments and mandatory contributions of PCSO () 4.) Premium contributions of members (naay bayaran sa philhealth monthly) 5.) Annual appropriations of DOH 6.) National Gov't subsidy to PhilHealth 7.) Supplemental funding
Appropriations (daghan kwarta needed for this law)
population-based health services
DOH to contract province-wide and city-wide health systems with the following minimum components.
Five thousand pesos (₱5,000.00), total number of affected employees, 6 months to 1 year,
Deducts, directly or indirectly, from the compensation of the covered employees or otherwise recover from them the employer's own contribution on behalf of such employees shall be punished with a fine of _______ multiplied by the ________ or imprisonment of _______, or both such fine and imprisonment, at the discretion of the court.
1.) Creation of a health promotion bureau in the DOH 2.) Incorporation of health promotion in school curricula 3.) DepEd schools to be designed as healthy settings 4.) LGU to enact stricter ordinances to promote health literacy and healthy lifestyle 5.) Evidence-informed sectoral policy and planning for UHC 6.) Monitoring and evaluation 7.) Health impact assessment 8.) Health technology assessment 9.) Health information system
Governance and accountability (we work hand in hand for the appropriation of this law)
- immediately eligibility - no co-payment in basic or ward accommodation - co-payment/co-insurance for amenities in public hospitals - no reduction in current PhilHealth package - additional benefits for direct contributors
NHIP
Five thousand pesos (₱5,000.00) but not more than Twenty thousand pesos (₱20,000.00)
Other violations of the provisions of this Act or of the rules and regulations promulgated by PhilHealth shall be punished with a fine of not less than __________.
Philippine Amusement and Gaming Corporation
PAGCOR
1.) Health care provider of population-based health services 2.) Health care provider of individual-based health services 3.) PhilHealth member and employer 4.) Director, officer or employee of PhilHealth
Penal provisions
five (5) members from the Senate, five (5) members from the House of Representatives
The Joint Congressional Oversight Committee shall be jointly chaired by the Chairpersons of the Senate Committee on Health and Demography and the House of Representatives Committee on Health. It shall be composed of _________ and _________, to be appointed by the Senate President and the Speaker of the House of Representatives, respectively
simplification of NHIP membership pooling of funds to philphealth
What's in NHI program?
Feb. 20, 2019 by Pres. Duterte
When was this act approved?
scholarship and training program 1.) expansion of health-related degree and training programs 2.) regulation of enrollees based on health needs 3.) expansion of scholarship grants for undergraduate and graduate programs 4.) setting up of registry of medical and allied health professionals 5.) reorientation of health professional education, certification and regulation for provision of primary care services return service agreement 1.) return service for at least three years for government-funded scholars 2.) Provision of additional incentives for those rendering additional two years of service 3.) Establishment of guidelines for non-compliance
human resource for health
Service coverage
immediate ELIGIBILITY & ACCESS to population-based and individual-based health services
imprisonment, six (6) months and one (1) day up to six (6) years
penal provisions includes _______ for _________, upon discretion of the court without prejudice to criminal liability defined under the Revised Penal Code.
individual-based health services
philhealth to contract public, private or mixed health care provider networks that would agree on
· Integrated and comprehensive approach to ensure health literacy, healthy living, and protection from hazards and risks · Whole-of-system, whole-of-government, whole-of-society approach in the development of health policies · Health care model that provides comprehensive health services causing financial hardship · People-oriented approach centered on people's needs and well-being
the declaration of principles
National health human resources master plan
this is to provide appropriate policies and strategies for health workforce based on population needs, and for permanent employment and competitive salaries
population-based health services Individual-based health services
two based health services of financial coverage?
national health human resources master plan national health workforce support system
what are the human resources for health?
direct contributors indirect contributors
what are the two contributors under simplification of NHIP membership?
