RA 11223, RA 10606
B. Traditional and Alternative Health Care
The application of traditional knowledge, skills and practice of alternative health care or healing methods which include reflexology, acupuncture, massage, accupressure, chiropractics, nutritional therapy and other similar methods in accordance with the accreditation guidelines set forth by the Corporation and the FDA. A. Case-based Payment B. Traditional and Alternative Health Care C. Lifetime Member D. Members in the Formal Economy E. Members in the Informal Economy
A. Both statements are correct.
Reimbursement Limits for Drugs and Medicines I. The Board shall provide for a process to determine the price index of drugs and medicines included in the PNDF and reimbursable by the Corporation. II. Reimbursement shall only be made for drugs and medicines within the allowable mark-up price. A. Both statements are correct. B. Both statements are wrong. C. First statement is correct. Second statement is wrong. D. First statement is wrong. Second statement is correct.
A. Point of contact
Service Delivery Structure Continuing, comprehensive, and coordinated referral system managed by a primary care provider A. Point of contact B. Provider
A. Point of contact
Service Delivery Structure First-contact care sought at any level of care A. Point of contact B. Provider
B. Provider
Service Delivery Structure Fragmented delivery of services at various levels of care A. Point of contact B. Provider
B. Provider
Service Delivery Structure HCPNs organized within province- or city-wide health systems A. Point of contact B. Provider
C. 8, 9 and 10 Summary 1. Increasing Physical Space 2. Increase capacity to deliver the supply 3. Health promotion 4. HTA 5. Workforce 6. Benefits 7. Data
Summary, except 1. Increasing Physical Space 2. Increase capacity to deliver the supply 3. Health promotion 4. HTA 5. Workforce 6. Benefits 7. Data 8. Platform 9. Training 10. Delivery A. 1, 2, 4 and 8 B. 2, 6, 8 and 10 C. 8, 9 and 10 D. 1, 5, and 10
B. I, II, and III
Suspension/Revocation of Accreditation I. Suspension of accreditation shall not exceed six (6) months. II. Suspension of the rights of members shall not exceed six (6) months. III. The revocation of a health care provider's accreditation shall operate to disqualify him from obtaining another accreditation in his own name, under a different name, or through another person, whether natural or juridical. A. I and III B. I, II, and III C. I, and III D. I and II
C. Service Delivery Structure
To address the fragmentation of service delivery and move towards providing comprehensive and integrated care, providers are encouraged to form province- and city-wide HCPNs. A. Health Workforce B. Access to Medical Products C. Service Delivery Structure
C. Population coverage
Universal Health coverage/care All people A. Service coverage B. Financial risk protection C. Population coverage
A. Service coverage
Universal Health coverage/care Having access to quality health services A. Service coverage B. Financial risk protection C. Population coverage
B. Financial risk protection
Universal Health coverage/care Without suffering financial hardship associated with paying for care A. Service coverage B. Financial risk protection C. Population coverage
B. RA 11223
Universal Healthcare Act (UHC Law) A. RA 11225 B. RA 11223 C. RA 11252
B. Health Information Systems
have been challenged by lack of structural and technical capacities, duplication of efforts, and unconsolidated and incomplete data, which are required in licensing and contracting agreements. A. Health Workforce B. Health Information Systems C. Service Delivery Structure
B. UHC Law Mandates
Province - and city-wide integration of administrative, technical, financial, and operational management of local health systems. A. Before UHC Law B. UHC Law Mandates
C. Local Government (Provincial and Municipal Offices)
Province - and city-wide integration of administrative, technical, financial, and operational management of local health systems. A. Leadership and Governance B. National Government C. Local Government (Provincial and Municipal Offices)
A. Mandatory Coverage
Provisions All citizens of the Philippines shall be covered by the National Health Insurance Program. A. Mandatory Coverage B. Enrollment C. Health Insurance Identification (ID) Card and ID Number
B. Enrollment
Provisions The Corporation shall enroll beneficiaries in order for them to avail of benefits under this Act. A. Mandatory Coverage B. Enrollment C. Health Insurance Identification (ID) Card and ID Number
B. Leadership and Governance
The UHC Law aims to clarify and delineate the overlapping functions of government agencies. A. Healthcare coverage/care B. Leadership and Governance C. Partnership
C. Lifetime Member
A former member who has reached the age of retirement under the law and has paid at least one hundred twenty (120) monthly premium contributions. A. Case-based Payment B. Traditional and Alternative Health Care C. Lifetime Member D. Members in the Formal Economy E. Members in the Informal Economy
B. Outpatient care
Benefit Package Prescription drugs and biologicals, subject to the limitations A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective
A. Inpatient hospital care
Benefit Package Prescription drugs and biologicals, subject to the limitations; and A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.
A. Inpatient hospital care
Benefit Package Room and board; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.
A. Inpatient hospital care & B. Outpatient care
Benefit Package Services of health care professionals; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective
A. Inpatient hospital care
Benefit Package Use of surgical or medical equipment and facilities; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.
C. Health Insurance Identification (ID) Card and ID Number
Provisions the Corporation through its local office shall issue a health insurance ID with a corresponding ID # which shall be used for purposes of identification, eligibility verification, and utilization recording A. Mandatory Coverage B. Enrollment C. Health Insurance Identification (ID) Card and ID Number
B. Entitlement to Benefits
A member whose premium contributions for at least three (3) months have been paid within (6) months prior to the first day of availment, including those of the dependents. A. Formal Economy B. Entitlement to Benefits C. Indigent
B. Procurement
Access to Medical Products Centralized or pooled procurement mechanisms for drugs and medical devices to leverage economies of scale and improve negotiation leverage A. Prioritization B. Procurement
A. Prioritization
Access to Medical Products HTA institutionalized through an HTA Council for all medical goods A. Prioritization B. Procurement
B. Procurement
Access to Medical Products Inefficient per facility procurement prone to bidding failures and ultimately stockouts A. Prioritization B. Procurement
A. Prioritization
Access to Medical Products No institutionalized, objective, and transparent prioritization process A. Prioritization B. Procurement
B. Accreditation
All health care providers operating for at least three (3) years may apply for accreditation. A. Reliance B. Accreditation C. Salient points
B. Universal Health coverage/care
All people having access to quality health services without suffering the financial hardship associated with paying for care A. Universal Healthcare Act B. Universal Health coverage/care C. Universal Leadership and Governance
A. RA 7875
Amendments NHIA 1995 A. RA 7875 B. RA 9241
B. RA 9241
Amendments NHIA 2004 A. RA 7875 B. RA 9241
B. Leadership and Governance
At the local level, the public system will be reorganized as province- or city-wide health systems, within which health care provider networks (HCPNs) will be formed. A. Healthcare coverage/care B. Leadership and Governance C. Partnership
A. Inpatient hospital care
Benefit Package 1. Room and board; 2. Services of health care professionals; 3. Diagnostic, laboratory, and other medical examination services; 4. Use of surgical or medical equipment and facilities; 5. Prescription drugs and biologicals, subject to the limitations; and 6. Inpatient education packages; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.
A. Inpatient hospital care & B. Outpatient care
Benefit Package Diagnostic, laboratory, and other medical examination services; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective
A. Inpatient hospital care
Benefit Package Inpatient education packages; A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.
B. Outpatient care
Benefit Package Personal preventive services ; and A. Inpatient hospital care B. Outpatient care C. Emergency and transfer services; and D. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective
D. HTAC Subcommittees • Composed of 7 subcommittees. - Drugs - Vaccines - Clinical equipment and devices - Medical and surgical procedures - Preventive and promotive health services - Traditional medicine - Other health technologies.
Composed of 7 subcommittees. A. HTA (Health Technology Assessment) B. HTAC (Health Technology Assessment Council) C. Committees D. HTAC Subcommittees
C. 9 voting members
Core Committees - _ voting members A. 3 voting members B. 6 voting members C. 9 voting members
B. False (3 months) Entitlement to Benefits - A member whose premium contributions for at least three (3) months have been paid within (6) months prior to the first day of availment, including those of the dependents.
Entitlement to Benefits - A member whose premium contributions for at least two (2) months have been paid within (6) months prior to the first day of availment, including those of the dependents. A. True B. False
C. A, B, and F a. Fifth and subsequent normal obstetrical deliveries; b. Non-prescription drugs and devices; c. Alcohol abuse or dependency treatment; d. Cosmetic surgery; e. Optometric services; and f. Cost-ineffective procedures as defined by the Corporation.
Exclusions Expenses for the following services shall not be covered by the NHIP, except a. Fourth and subsequent normal obstetrical deliveries; b. Prescription drugs and devices; c. Alcohol abuse or dependency treatment; d. Cosmetic surgery; e. Optometric services; and f. Cost-effective procedures as defined by the Corporation. A. A, B, C, A, and E B. A, B, E, and F C. A, B, and F D. C, D, and F
C. Coverage
Financing Guaranteed PhilHealth membership for all citizens; Simplifies, two-tiered membership scheme - direct (contributory) or indirect (subsidized); A. Salaries B. Purchaser C. Coverage D. Fund source
C. Coverage
Financing Multiple membership schemes that make member management inefficient A. Salaries B. Purchaser C. Coverage D. Fund source
A. Salaries
Financing No change; intervening laws, civil service regulation, and political landscape restrict opportunities to move to performance based payment of salaries A. Salaries B. Purchaser C. Coverage D. Fund source
D. Fund source
Financing Overlap in population and individual-based services funded by DOH and PhilHealth A. Salaries B. Purchaser C. Coverage D. Fund source
B. Purchaser
Financing PhilHealth purchases services from providers through piecemeal benefit packages and reimbursements A. Salaries B. Purchaser C. Coverage D. Fund source
D. Fund source
Financing Population-based services financed by DOH and LGUs; Individual-based services financed by PhilHealth A. Salaries B. Purchaser C. Coverage D. Fund source
B. Purchaser
Financing Prospective, performance-based, global budget payments for HCPNs A. Salaries B. Purchaser C. Coverage D. Fund source
A. Salaries
Financing Public sector salaries paid by national and/or local government A. Salaries B. Purchaser C. Coverage D. Fund source
A. Before UHC Law
Fragmented administrative, technical, financial, and operational management of local health systems (primary to tertiary care) down to individual municipalities. A. Before UHC Law B. UHC Law Mandates
C. Local Government (Provincial and Municipal Offices)
Fragmented administrative, technical, financial, and operational management of local health systems (primary to tertiary care) down to individual municipalities. A. Leadership and Governance B. National Government C. Local Government (Provincial and Municipal Offices)
A. Before UHC Law
Gaps in licensing and regulation of health facilities by DOH, particularly primary care facilities. A. Before UHC Law B. UHC Law Mandates
B. National Government
Gaps in licensing and regulation of health facilities by DOH, particularly primary care facilities. A. Leadership and Governance B. National Government C. Local Government (Provincial and Municipal Offices)
A. I only
HTAC (Health Technology Assessment Council), except • Created by the FDA • It provides guidance to the DOH and PhilHealth on the coverage of health interventions and technologies. • HTAC undertakes technology appraisal by determining their clinical and economic values in the Philippine healthcare system A. I only B II only C. III only
B. False (Each Subcommittee has three (3) non-voting members.)
HTAC Subcommittees • Each Subcommittee has two (2) non-voting members. A. True B. False
B. Primary care certification
Health Workforce Certification based on primary care competencies required for primary care providers A. Training B. Primary care certification
A. Training
Health Workforce General undergraduate training as default primary care training, but with recognized inadequacies A. Training B. Primary care certification
B. Primary care certification
Health Workforce No required certification to practice primary care A. Training B. Primary care certification
A. True
Health Workforce The law also focuses on strengthening the provision of primary care through appropriate training of human resources. A. True B. False
B. False (disadvantaged areas)
Health Workforce There is a chronic deficiency of healthcare professionals, especially in geographically isolated and advantaged areas. A. True B. False
B. False (will expand)
Health Workforce To address healthcare worker deficiency in the short term, the DOH will not expand its deployment programs to augment workforce needs. A. True B. False
A. Training
Health Workforce Undergraduate and graduate training and curricula designed and realigned to focus on primary care competencies A. Training B. Primary care certification
C. None of the above
Health Workforce, except • There is a chronic deficiency of health care professionals, especially in geographically isolated and disadvantaged areas. • To address healthcare worker deficiency in the short term, the DOH will expand its deployment programs to augment workforce needs. • The law also focuses on strengthening the provision of primary care through appropriate training of human resources A. I only B. II only C. None of the above
A. Case-based Payment
Hospital payment method that reimburses to hospitals a predetermined fixed rate for each treated case or disease; also called per case payment. A. Case-based Payment B. Traditional and Alternative Health Care C. Lifetime Member D. Members in the Formal Economy E. Members in the Informal Economy
B. National government and/or LGUs and/or legislative sponsor
How about the coverage of unenrolled women who are about to give birth? A. Payment for Sponsored Members' Contributions B. National government and/or LGUs and/or legislative sponsor C. All health care providers operating for at least three (3) years may apply for accreditation.
A. Payment for Sponsored Members' Contributions
How about the premium contribution of orphans, PWDs, SC, barangay health workers, kasambahay? A. Payment for Sponsored Members' Contributions B. National government and/or LGUs and/or legislative sponsor C. All health care providers operating for at least three (3) years may apply for accreditation.
D. HTAC Subcommittees
It supports the HTA Core Committee in achieving timely, efficient, and responsive technology appraisal process. A. HTA (Health Technology Assessment) B. HTAC (Health Technology Assessment Council) C. Committees D. HTAC Subcommittees
B. UHC Law Mandates
Mandatory licensing and regulatory systems by DOH for all health facilities, including primary care facilities. A. Before UHC Law B. UHC Law Mandates
B. National Government
Mandatory licensing and regulatory systems by DOH for all health facilities, including primary care facilities. A. Leadership and Governance B. National Government C. Local Government (Provincial and Municipal Offices)
C. RA 10606
National Health Insurance Act of 2013 (S. No. 2849 and H. No. 6048) A. RA 10767 B. RA 8172 C. RA 10606
A. True
PhilHealth Membership, Benefits, and Financing, except • PhilHealth membership is currently achieved through a variety of subsidized and contributory schemes. A. True B. False
D. None of the above
PhilHealth Membership, Benefits, and Financing, except • PhilHealth membership is currently achieved through a variety of subsidized and contributory schemes. • All citizens are automatically entitled to • PhilHealth benefits, including comprehensive outpatient services • The law strengthens PhilHealth by transforming it to become a national purchaser of individual-based health goods and services A. I and IV B. III only C. All of the above D. None of the above
C. July 23, 2013
RA 10606 National Health Insurance Act of 2013 (S. No. 2849 and H. No. 6048) A. June 23, 2013 B. July 25, 2018 C. July 23, 2013
C. February 20, 2019
RA 11223 Universal Healthcare Act (UHC Law) A. February 15, 2019 B. February 20, 2018 C. February 20, 2019
C. IV only
RA 11223 Universal Healthcare Act (UHC Law), except • It seeks to revitalize health care through a whole-of-system, whole-of-government, whole-of-society, people-centered approach. • This law seeks to provide all Filipinos access to a set of quality and cost-effective care without causing financial hardship. The law prioritizes the needs of the people who, by economic status, may not be able to afford healthcare services. • It mandates the institutionalization of HTA as a fair and transparent priority setting mechanism. • The UHC Law aims to clarify and delineate the overlapping functions of government agencies. A. I only B. II and III C. IV only
C. Access to Medical Products
The Philippine market for medical products lacks effective government coordination and control, and its inefficiency has led to uniquely high drug prices. A. Health Workforce B. Health Information Systems C. Access to Medical Products
C. Service Delivery Structure
The delivery of public PHC services is currently controlled at the barangay and municipality level. A. Health Workforce B. Access to Medical Products C. Service Delivery Structure
A. 1st statement is correct. 2nd statement is wrong. • Members and/or their dependents shall be eligible to avail of benefits for confinement/s outside the country: • Provided, that the conditions for entitlement are met and the following requirements are submitted within 180 calendar days from the date of discharge:
What if a member or their dependents are confined in abroad? Are they covered by the NHIP? • Members and/or their dependents shall be eligible to avail of benefits for confinement/s outside the country: • Provided, that the conditions for entitlement are met and the following requirements are submitted within 160 calendar days from the date of discharge: A. 1st statement is correct. 2nd statement is wrong. B. 1st statement is wrong. 2nd statement is correct. C. Both statements are correct. D. Both statements are incorrect.
B. Informal economy
Where to get the fund? (a) Contribution from Program members based primarily on household earnings and assets/ subsidized by the LGU. A. Formal economy B. Informal economy C. Indigent
C. Indigent
Where to get the fund? (a) Contribution from Program members not exceed the min contributions for employed members. Fully subsidized by the national government. A. Formal economy B. Informal economy C. Indigent
A. Formal economy
Where to get the fund? (a) Contribution from Program members; (NMT 5% of monthly salaries) A. Formal economy B. Informal economy C. Indigent
A. HTA (Health Technology Assessment)
Will serve as a fair and transparent priority setting mechanism in the development of policies and programs, regulation, and determination of a range of entitlements to all Filipinos A. HTA (Health Technology Assessment) B. HTAC (Health Technology Assessment Council) C. Committees D. HTAC Subcommittees
E. Members in the Informal Economy
Workers who are not covered by formal contracts or agreements and whose premium contributions are self-paid or subsidized by another individual through a defined criteria set by the Corporation. A. Case-based Payment B. Traditional and Alternative Health Care C. Lifetime Member D. Members in the Formal Economy E. Members in the Informal Economy
D. Members in the Formal Economy
Workers with formal contracts and fixed terms of employment including workers in the government and private sector, whose premium contribution payments are equally shared by the employee and the employer. A. Case-based Payment B. Traditional and Alternative Health Care C. Lifetime Member D. Members in the Formal Economy E. Members in the Informal Economy
A. True
• The following need not pay the monthly contributions to be entitled to the Program's benefits: - ***Retirees and pensioners of the SSS and GSIS prior to the effectivity of this Act; and - ***Lifetime members - ***Enrolled indigents A. True B. False