AN ACT INSTITUTING UNIVERSAL HEALTH CARE
FOR ALL FILIPINOS, PRESCRIBING REFORMS IN THE HEALTH CARE SYSTEM, AND
APPROPRIATING FUNDS THEREFOR
Section 1
Short Title
This Act shall
be known as the “Universal Health Care Act.”
Section 2
Declaration
of Principles and Policies
It is the
policy of the State to protect and promote the right to health of all Filipinos
and instill health consciousness among them. Towards this end, the State shall
adopt:
(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 hardships, 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.
Section 3
General
Objectives
This Act seeks
to:
(a)
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; and
(b)
Ensure that all Filipinos are guaranteed equitable access to
quality and affordable health care goods and services, and protected against
financial risk.
Section 4
Definition
of Terms
As used in this
Act:
(a)
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;
(b)
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;
(c)
Basic or ward accommodation refers to the provision of regular meal, bed in shared room,
fan ventilation and shared toilet and bath;
(d)
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;
(e)
Co–payment
refers to a flat fee or predetermined rate paid at point of service;
(f)
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;
(g)
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 less of
her unborn child, or a non–institutional delivery;
(h)
Entitlement refers
to any singular or package of health services provided to Filipinos for the
purpose of improving health;
(i)
Essential health benefit package refers to a set of individual–based
entitlements covered by the National Health Insurance Program (NHIP) which
include primary care; medicines, diagnostics and laboratory; and preventive,
curative, and rehabilitative services;
(j)
Fraudulent act refers
to any act of misrepresentation or deception resulting in undue benefit or
advantage on their part of the doer or any means that deviate from normal
procedure and is undertaken for personal gain, resulting thereafter to damage
and prejudice which may be capable of pecuniary estimation;
(k)
Health care provider
refers to any of the following:
(1)
A health facility, which may be public or private,
devoted primarily to the provision of services for health promotion,
prevention, diagnosis, treatment, rehabilitation and palliation of individuals
suffering from illness, disease, injury, disability, or deformity, or in need of
obstetrical or other medical and nursing care;
(2)
A health care professional, who may be a doctor of
medicine, nurse, midwife, dentist or other allied health professional or
practitioner duly licensed to practice in the Philippines;
(3)
A community–based health care organization, which is an association of members of the
community organized for the purpose of improving the health status of that
community; or
(4)
Pharmacies or drug outlets, laboratories and diagnostic
clinics.
(l)
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;
(m) 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;
(n)
Health Technology Assessment (HTA) refers to the systematic evaluation of
properties, effects, or impacts 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;
(o)
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;
(p)
Individual–based health services refer to services which can be accessed
within a health facility or remotely that can be definitively trace back to one
(1) recipient, has limited effect at population level and does not alter the
underlying cause of illness such as ambulatory and inpatient care, medicines,
laboratory tests and procedures, among others;
(q)
Population–based health services refer to interventions such as health
promotion, disease surveillance, and vector control, which have population
groups as recipients;
(r)
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 referral to other health
care providers in the health care delivery system, when necessary;
(s)
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 institutions that is licensed and certified by the DOH;
(t)
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; and
(u)
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 person’s profession or practice, or
other similar analogous acts that put or trend to put or tend to put in
disrepute the integrity and effective implementation of NHIP.
Section 5
Population
Coverage
Every Filipino
citizen shall be automatically included into the NHIP, hereinafter referred to
as the Program.
Section 6
Service
Coverage
(a)
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;
(b)
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;
(c)
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 coordinated by the primary care provider;
and
(d)
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.
Section 7
Financial
Coverage
(a)
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.
The
National Government shall support LGUs in the financing of capital investments
and provision of population based interventions.
(b)
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.
Section 8
Program
Membership
Membership into
the Program shall be simplified into two (2) types, direct contributors and
indirect contributors, as defined in Section 4 of this Act.
Section 9
Entitlement
to Benefits
Every member
shall be granted immediate eligibility for health benefits package under the
Program: Provided, that PhilHealth Identification card shall not be required in
the availment of any health service: Provided, further, that no co–payment
shall be charged for services rendered in basic or ward accommodation:
Provided, furthermore, that co– payments and co–insurance for amenities in
public hospitals shall be regulated by the DOH and PhilHealth: Provided,
finally, that the current PhilHealth package for members shall not be reduced.
PhilHealth
shall provide additional Program benefits for direct contributors, where
applicable: Provided, that failure to pay premiums shall not prevent the
enjoyment of any Program benefits: Provided, further, that employers and
self–employed direct contributors shall be required to pay all missed
contributions with an interest, compounded monthly, of at least three percent
(3%) for employers and not exceeding one and one–half percent (1.5%) for
self–earning, professional practitioners, and migrant workers.
Section 10
Premium
Contributions
For direct
contributors, premium rates shall be in accordance with the following schedule,
and monthly income floor and ceiling:
Year
|
Premium Rate
|
Income Floor
|
Income Ceiling
|
2019
|
2.75 %
|
10,000.00
|
50,000.00
|
2020
|
3.00 %
|
10,000.00
|
60,000.00
|
2021
|
3.50 %
|
10,000.00
|
70,000.00
|
2022
|
4.00 %
|
10,000.00
|
80,000.00
|
2023
|
4.50 %
|
10,000.00
|
90,000.00
|
2024
|
5.00 %
|
10,000.00
|
100,000.00
|
2025
|
5.00 %
|
10,000.00
|
100,000.00
|
Provided, That
for indirect contributors, premium subsidy shall be gradually adjusted and
included annually in the General Appropriations Act (GAA): Provided, further,
That the funds shall be released to PhilHealth: Provided, furthermore; That the
DOH, in coordination with PhilHealth, may request Congress to appropriate
supplemental funding to meet targeted milestones of this Act: Provided,
finally, That for every increase in the rate of contribution of direct
contributors and premium subsidy of indirect contributors, PhilHealth shall
provide for a corresponding increase in benefits.
Section 11
Program
Reserve Funds
PhilHealth
shall set aside a portion of its accumulated revenues not needed to meet the
cost of the current year’s expenditure as reserve funds: Provided, That the
total amount of reserves shall not exceed of ceiling equivalent to the amount
actuarially estimated for two (2) years’ projected Program expenditures:
Provided, further, That whenever actual reserves exceed the required ceiling at
the end of the fiscal year, the excess of the PhilHealth reserve fund shall be
used to increase the Program’s benefits and to decrease the amount of members’
contributions.
Any unused
portion of the reserve fund that is not needed to meet the current expenditure
obligations or support the above mentioned programs shall be placed in
investments to earn an average annual income at prevailing rates of interest
and shall be referred to as the Investment Reserve Fund. The Investment Reserve
Fund shall be invested in any or all of the following:
(a)
In interest–bearing bonds, securities or other evidences of
indebtedness of the Government of the Philippines: Provided, that such
investment shall be at least fifty percent (50%) of the reserve fund;
(b)
In debt securities and corporate bonds of prime or solvent
corporations created or existing under the laws of the Philippines: Provided,
that the issuing or its predecessor entity shall not have defaulted in the
payment of interest on any of its securities: Provided, further, That the
securities are issued by companies with high growth opportunities and earning
potentials: Provided, finally, that such investment shall not exceed thirty
percent (30%) of the reserve fund;
(c)
In interest–bearing deposits and loans to or securities in any
domestic bank doing business in the Philippines: Provided, that in the case of
such deposits, this shall not exceed at any time the unimpaired capital and
surplus or total private deposits of the depository bank, whichever is smaller:
Provided, further, That the bank shall have been designated as a depository for
this purpose by the Monetary Board of the Banco Central ng Filipinas.
(d)
In preferred stocks of any solvent corporation or institutions
created or existing under the laws of the Philippines listed in the stock
exchange with proven track record or profitability over the last three (3)
years and payment of dividends for a period of at least three (3) years
immediately preceding the date of investment in such preferred stocks;
(e)
In common stocks of any solvent corporation or institution
created or existing under the laws of the Philippines listed in the stock
exchange with high growth opportunities and earning potentials;
(f)
In bonds, securities, promissory notes, or other evidences of
indebtedness of accredited and financially sound medical institutions
exclusively to finance the construction, improvement and maintenance of
hospitals and other medical facilities: Provided, that such securities and
instruments shall be guaranteed by the Republic of the Philippines or the
issuing medical institutions and the issued securities are both rated triple
“A” by authorized accredited domestic rating agencies: Provided, further, That
said investments shall not exceed ten percent (10%) of the total reserve fund;
and
(g)
In debt instruments and other securities traded in the
secondary markets with the same intrinsic quality as those enumerated in
paragraphs (a) to (e) hereof, subject to the approval of the PhilHealth Board.
No
portion of the reserve fund or income thereof shall accrue to the general fund
of the National Government or to any of its agencies or instrumentalities,
including government–owned or government–controlled corporations.
As
part of its investments operations, PhilHealth may hire institutions with valid
trust license as its external local fund managers to manage the reserve fund,
as it may deem appropriate, through public bidding. The fund manager shall
submit an annual report on investment performance to PhilHealth.
The
PhilHealth shall set up the following funds:
(1)
A fund to secure benefit payouts to members prior to their
becoming lifetime members;
(2)
A fund to secure payouts to lifetime members; and
(3)
A fund for optional supplemental benefits that are subject to
additional contributions.
A
portion of each of the above funds shall be identified as current and kept in
liquid instruments. In no case shall said portion be considered part of
invested assets.
The
PhilHealth shall allocate a portion of all contributions to the fund for
lifetime members based on an allocation to be determined by the PhilHealth
actuary based on a pre–determined percentage using the current average age of
members and the current life expectancy and morbidity curve of Filipinos.
The
PhilHealth shall manage the supplemental benefits and the lifetime members’
fund in an actuarially sound manner.
The
PhilHealth shall manage the supplemental benefits fund to the minimum required
to ensure that the supplemental benefit payments are secure.
Section 12
Administrative
Expense
No more than
seven and one–half percent (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.
Section 13
PhilHealth
Board of Directors
(a)
The PhilHealth Board of Directors, hereinafter referred to as
the Board, is hereby reconstituted to have a maximum of thirteen (13) members,
consisting of the following:
(1)
Five (5) ex officio members namely: The Secretary of Health,
Secretary of Social Welfare and Development, Secretary of Budget and
Management, Secretary of Finance, Secretary of Labor and Employment;
(2)
Three (3) expert panel members with expertise in public
health, management, finance, and health economics; and
(3)
Five (5) 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
executive 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 (1) of the expert panel members and at least two
(2) of the sectoral panel members are women.
The
sectoral and expert panel members must be Filipino citizens and of good moral
character.
The
expert panel members must:
(i) Be of recognized probity and independence and must have
distinguished themselves professionally in public, civic or academic service;
(ii) Be in the active practice of their professions for at least
seven (7) years; and
(iii) Not be appointed within one (1) year after losing in the
immediately preceding elections, whether regular or special.
(iv) The Secretary of Health shall be an ex officio nonvoting
Chairperson of the Board.
(v) 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. Noncompliance shall be
ground for dismissal.
Within
thirty (30) days following the effectivity of this Act, the Governance Commission
for Government–Owned or Government–Controlled Corporations (GCG) shall, in
accordance with the provisions of Republic Act No. 10149, promulgate the
nomination and selection process for appointive members of the Board with a
clear set of qualifications, credentials, and recommendations from the
concerned sectors.
Section 14
President
and Chief Executive Officer (CEO) of PhilHealth
Upon
recommendation of the Board, the President of the Philippines shall appoint the
President and CEO of PhilHealth from the Board’s non–ex officio members:
Provided, That the Board cannot recommend a President and CEO of PhilHealth
unless the member is a Filipino citizen and must have at least seven (7) years
of experience in the field of public health, management, finance, and health
economics or a combination of any this expertise.
Section 15
PhilHealth
Personnel as Public Health Workers
All PhilHealth
personnel shall be classified as public health workers in accordance with the
pertinent provisions under Republic Act No. 7305, also known as the Magna Carta
of Public Health Workers.
Section 16
Additional
Powers and Functions of PhilHealth
(a)
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. The compensation
plan shall be comparable with government social security institutions and shall
be subject to periodic review by the Board no more than once every four (4)
years without prejudice to merit reviews or increases based on productivity and
efficiency;
(b)
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;
(c)
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; and
(d)
To adopt or approve the annual and supplemental budget of
receipts and expenditures including salaries, allowances and early retirements
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: Provided, That this shall be subject to
the budgetary limitations stated under Section 12 hereof: Provided, further,
That the submission of the corporate budget to the Department of Budget and
Management (DBM) shall be for information purposes only.
Section 17
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. Province–wide and city–wide
health systems shall have the following minimum components:
(1)
Primary care provider network with patient records accessible
throughout the health system;
(2)
Accurate, sensitive, and timely epidemiologic surveillance
systems; and
(3)
Proactive and effective health promotion programs or
campaigns.
Section 18
Individual–based
Health Services
(a)
PhilHealth shall endeavor to contract public, private, or
mixed health care provider networks for the delivery of individual–based health
services: Provided, That member access to services shall not be compromised:
Provided, further, That these networks agree to service quality,
co–payments/co–insurance, and data submission standards: Provided, furthermore,
That during the transition, PhilHealth and DOH shall incentivize health care
providers that form networks: Provided, finally, That apex or end–referral
hospitals, as determined by the DOH, may be contracted as stand–alone health
care providers by PhilHealth.
(b)
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; develop differential payment schemes
that give due consideration to service quality, efficiency and equity; and
institute strong surveillance and audit mechanisms to ensure networks’
compliance to contractual obligations.
Section 19
Integration
of Local Health Systems into Province–wide and City–wide Health System
The DOH,
Department of the Interior and Local Government (DILG), PhilHealth and the LGUs
shall endeavor to integrate health systems into province–wide and city–wide health
systems. The Provincial and City Health Board shall oversee and coordinate the
integration of health systems, to be composed of municipal and component city
health systems, and city–wide health systems in highly urbanized and
independent component cities, respectively. The Provincial and City Health
Board shall manage the Special Health Fund referred to in Section 20 of this
Act and shall exercise administrative and technical supervision over health
facilities and health human resources within their respective territorial
jurisdiction: Provided, that municipalities and cities included in province–wide
and city–wide health systems shall be entitled to a representative in the Provincial
or City Health Board, as the case may be.
Section 20
Special
Health Fund
The
province–wide or city–wide health system shall pool and manage, through a
special health fund, all resources intended for health services to finance
population–based and individual–based health services, health system operating
costs, capital investments, and remuneration of additional health workers and
incentives for all health workers: Provided, That the DOH, in consultation with
the DBM and the LGUs, shall develop guidelines for the use of the Special
Health Fund.
Section 21
Income
Derived from PhilHealth Payments
All income
derived from PhilHealth payments shall accrue to the Special Health Fund to be
allocated by the LGUs exclusively for the improvement of the LGU health system:
Provided, That PhilHealth payments shall be credited to the Annual Regular Income
(ARI) of the LGU.
Section 22
Incentives
for Improving Competitiveness of the Public Health Service Delivery System
The National
Government shall make available commensurate financial and non–financial
matching grants, including capital outlay, human resources for health and health
commodities, to improve the functionality of province–wide and city–wide health
systems: Provided, that undeserved and unserved areas shall be given priority
in the allocation of grants: Provided, further, That the grants shall in
accordance with the approved province–wide and city–wide health investment
plans, which shall account for complementation of public and private health
care providers and public and private health sector investments.
Section 23
National
Health Human Resource Master Plan
The DOH,
together with stakeholders, shall ensure the formulation and implementation of
a National Health Human Resource Master Plan that will provide policies and
strategies for the appropriate generation, recruitment, retraining, regulation,
retention and reassessment of health workforce based on population health
needs.
To ensure
continuity in the provision of the health programs and services, all health
professionals and health care workers shall be guaranteed permanent employment
and competitive salaries.
Section 24
National
Health Workforce Support System
A National
Health Workforce (NHW) support system shall be created to support local public
health systems in addressing their human resource needs: Provided, that
deployment to Geographically Isolated and Disadvantaged Areas (GIDAs) shall be
prioritized.
Section
25
Scholarship
and Training Program
(a)
The Commission on Higher Education (CHED), Technical Education
and Skills Development Authority (TESDA), Professional Regulation Commission (PRC)
and the DOH shall develop and plan the expansion of existing and new allied and
health–related degree and training programs including those for community–
based health care workers and regulate the number of enrollees in each program
based on the health needs of the population especially those in underserved areas.
(b)
The CHED and the DOH shall expand scholarship grants for
allied and health– related undergraduate and graduate programs: Provided, that
scholarships shall be based on the needed cadre of national and local health
managers and health professionals: Provided, further, that scholarships for
bona fide residents of unserved or underserved areas or members or indigenous
peoples shall be given priority.
(c)
The PRC and the DOH, in coordination with duly–registered
medical and allied health professional societies, shall set up a registry of
medical and allied health professionals, indicating among others, their current
number of practitioners and location of practice.
(d)
The CHED, PRC and DOH, in coordination with duly–registered
medical and allied professional societies, shall reorient medical and allied
medical professional education, and health professional certification and
regulation towards producing health workers with competencies in the provision
of primary care services.
Section 26
Return
Service Agreement
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: Provided, further, That those who will serve for
additional two (2) years shall be provided with additional incentives as
determined by the DOH: Provided, further, that graduates of allied and health–related
courses from state universities and colleges and private schools shall be
encourages to serve in these areas.
The DOH shall
coordinate with the CHED and PRC for the effective implementation of this
section including the establishment of guidelines for noncompliance.
Section 27
Safety and
Quality
(a)
PhilHealth shall establish a rating system under an incentive
scheme to acknowledge and reward health facilities that provide better service
quality, efficiency and equity: Provided, that PhilHealth shall recognize third
party accreditation mechanisms and may use these as basis for granting
incentives.
(b)
The DOH shall institute a licensing and regulatory system for
stand–alone health facilities, including those providing ambulatory and primary
care services, and other modes of health service provision.
(c)
The DOH shall set standards for clinical care through the
development, appraisal, and use of clinical practice guidelines in cooperation
with professional societies and the academe.
Section 28
Affordability
(a)
A DOH–owned health care providers shall procure drugs and
devices guided by price reference indices, following centrally negotiated
prices, sell them following the prescribed maximum mark–ups, and submit to DOH
a price list of all drugs and devices procured and sold by the health care
provider.
(b)
An independent price negotiation board, composed of
representatives from the DOH, PhilHealth and the Department of Trade and
Industry (DTI), among others, shall be constituted to negotiate prices on
behalf of the DOH and PhilHealth, guided by certain parameters including new
technology, innovator drugs, and sources from a single supplier: Provided, that
the negotiated price in the framework contract shall be applicable for all
health care providers under DOH: Provided, further, that the price negotiations
board shall adhere to the guidelines issued by the Government Procurement
Policy Board.
(c)
Health care providers and facilities shall be required to make
readily accessible to the public and submit to DOH and PhilHealth, all
pertinent, relevant and up–to–date information regarding the prices of health
services, and all goods and service being offered.
(d)
Drug outlets shall be required at all times to carry the
generic equivalent of all drugs in the Primary Care Formulary and shall be
required to provide customers with a list of therapeutic equivalents and their
corresponding prices when fulfilling prescriptions or in any transaction.
(e)
The DOH, PhilHealth, HMOs, life and non–life private health
insurance (PHIs) shall develop standard policies and plans that complement the
Program’s benefit schedule: Provided, that a coordination mechanism between
PhilHealth, PHIs and HMOs shall be set up to ensure that no benefits shall be
unnecessarily dropped.
Section 29
Equity
(a)
The DOH shall annually update its list of underserved areas,
which shall be the basis for preferential licensing of health facilities and
contracting of health services. The DOH shall develop the framework and
guidelines to determine the appropriate bed capacity and number of health care
professionals of public health facilities.
(b)
The government shall guarantee that the distribution of health
services and benefits provided for in this Act shall be equitable by
prioritizing GIDAs in the provision of assistance and support.
(c)
All government hospitals are required to operate not less than
ninety percent (90%) of their bed capacity as basic or ward accommodation:
Provided, that specialty hospitals are required to operate not less than
seventy percent (70%) of their bed capacity as basic or ward accommodation:
Provided, further, that private hospitals are required to operate not less than
ten percent (10%) of their bed capacity as basic or ward accommodation:
Provided, finally, that all government hospitals, specialty hospitals and
private hospitals shall regularly submit a report on the allotment or
percentage of their bed capacity to basic or ward accommodation to DOH, which
shall issue the necessary guidelines for the immediate implementation of this
provision.
Section 30
Health
Promotion
The DOH, as the
overall steward for health care, shall strengthen national efforts in providing
a comprehensive and coordinated approach to health development with emphasis on
scaling up health promotion and preventive care.
The DOH shall
transform its existing Health Promotion and Communication Service into a
full–fledged Bureau, to be named as the Health Promotion Bureau, to improve
health literacy and mainstream health promotion and protection.
The Health
Promotion Bureau shall formulate a framework strategy for health promotion
which shall serve as the basis for DOH programs in increasing health literacy
with focus on reducing non–communicable diseases, implement population–wide
health promotion programs and activities across social determinants of health,
exercise policy coordination across government instrumentalities to ensure the
attainment of the framework strategy and its programs, and promote and provide
technical support to local research and development programs and projects:
Provided, that within two (2) years from the effectivity of this Act, the cost
of implementing health promotion programs shall be at least one percent (1%) of
the DOH’s total budget appropriations.
The schools
under the supervision of the Department of Education (DepEd) are hereby
designated as healthy settings for the purpose of this Act. The DepEd, in
coordination with DOH, shall formulate programs and modules on health literacy
and rights to be integrated into the existing school curricula to intensify the
fight against the spread of communicable diseases and increase in prevalence of
non–communicable diseases through, among others, the effective promotion of
healthy lifestyle, physical activity, proper nutrition, and prevention of
smoking and alcohol consumption among students. The program shall likewise
acquaint the students on their entitlements, privileges and responsibilities
under this Act.
The DOH and
DepEd shall submit annual reports on the health promotion and literacy programs
they have respectively implemented, including an assessment of the impact
thereof, to the President of the Philippines, the Senate President, and the
Speaker of the House of Representatives.
Furthermore,
the LGUs are also directed to enact stricter ordinances that strengthen and
broaden existing health policies, the laws to the contrary notwithstanding, and
implement effective programs that promote health literacy and healthy lifestyle
among their constituencies to advance population health and individual wellbeing,
reduce the prevalence of non–communicable diseases and their risk factors,
particularly tobacco and alcohol use, lower the incidence of new infectious
diseases, address mental health issues and improve health indicators. An annual
report on the policies adopted and programs undertaken and an assessment of the
impact thereof shall be submitted by the LGUs to the DILG.
Section 31
Evidence–Informed
Sectoral Policy and Planning for UHC
(a)
All public and private, national and local health–related
entities shall be required to submit health and health–related data to
PhilHealth including among others, administrative, public health, medical,
pharmaceutical and health financing data: Provided, That PhilHealth shall
furnish the DOH a copy of the health data: Provided, further, that these shall
not be used for the purpose of generating information to guide research and
policy–making: Provided, finally, That the DOH shall strengthen its research
capability by supporting health systems development and reform initiatives
through policy and systems research, and shall support the growth of research
consortia in line with the vision of the Philippine National Health Research
System.
(b)
The DOH and Department of Science and Technology (DOST) shall
develop a cadre of policy systems researchers, technical experts and managers
by providing training grants in globally–benchmarked institutions: Provided,
that grantees shall be required to serve for at least three (3) full years,
under supervision and with compensation, in DOH, PhilHealth and other relevant
government agencies: Provided, further, that those who will serve for
additional two (2) years, shall be provided with additional incentives as
determined by the agency concerned.
(c)
All health, nutrition, demographic–related administrative and
survey data generated using public funds shall be considered public records and
be made accessible to the public unless otherwise prohibited by law: Provided,
that any person who requests a copy of such public records may be required to
pay the actual costs or reproduction and copying of the requested public
records.
(d)
Participatory action researches on cost–effective, high–impact
interventions for health promotion and social mobilization shall form part of
the national health research agenda of the Philippine National Health Research
System which shall also be mandated to provide adequate funding support for the
conduct of these researches.
Section 32
Monitoring
and Evaluation
(a)
The Philippine Statistics Authority (PSA) shall conduct the
relevant modules of household surveys annually during the first ten (10) years
of the implementation, and thereafter follow its regular schedule.
(b)
The DOH shall publish annual provincial burden of disease
estimates using internationally validated estimation methods and biennially
using actual public and private sector data from electronic records and disease
registries, to support LGUs in tracking progress of health outcomes.
Section 33
Health Impact
Assessment (HIA)
HIA shall be
required for policies, programs, and projects that are crucial in attaining
better health outcomes or those that may have an impact on the health sector.
Section 34
Health
Technology Assessment (HTA)
(a)
The HTA process shall be institutionalized as a fair and
transparent priority setting mechanism that shall be recommendatory to the DOH
and PhilHealth for the development of policies and programs, regulation, and
the determination of a range of entitlements such as drugs, medicines,
pharmaceutical products, and other devices, procedures and services as provided
for under this Act: Provided, That investments on any health technology or
development of any benefit package by the DOH and PhilHealth shall be based on
the positive recommendations of the HTA: Provided, further, that despite having
undergone the HTA process, all health technology, intervention or benefit
package shall still be subjected to periodic review: Provided, furthermore,
that a health technology assessment may be conducted as new evidence emerges
which may have substantial impact on the initial coverage decision by the DOH
or PhilHealth: Provided, finally, that the HTA process shall adhere to the
principles of ethical soundness, inclusiveness and preferential regard for the
underserved, evidence–based and scientific defensibility, transparency and
accountability, efficiency, enforceability and availability of remedies, and
due process.
(b)
The following criteria must be observed in the conduct of HTA:
(1) Responsiveness to
Magnitude, Severity, and Equity
The
health interventions must address the top medical conditions that place the
heaviest burden on the population, including dimensions of magnitude or the
number of people affected by a health problem, and severity or health loss by an
individual as a result of disease, such as death, handicap, disability or pain,
and conditions of the poorest and most vulnerable population;
(2) Safety and
Effectiveness
Each
intervention must have undergone Phase IV clinical trial, and systematic review
and meta–analysis must be readily available. The interventions must also not
pose any harm to the users and health care providers;
(3) Household Financial
Impact
The
interventions must reduce out–of–pocket expenses. Interventions must have
economic studies and cost–of–illness studies to satisfy this criterion;
(4) Cost–effectiveness
The
interventions must provide overall health gain to the health system and
outweigh the opportunity costs of funding drug and technology; and
(5) Affordability and
Viability
The
interventions must be affordable and the cost thereof must be viable to the financing
agents.
(c)
The HTAC, to be composed of health experts, shall be created
within the DOH and supported by a Secretariat and a Technical Unit for Policy,
Planning and Evaluation with evidence generation and validation capacity.
The
HTAC shall:
(1)
Facilitate provisions of financing and/or coverage
recommendations on health technologies to be financed by DOH and PhilHealth;
(2)
Oversee and coordinate the HTA process within DOH and
PhilHealth.
(3)
Review and assess existing DOH and PhilHealth benefit packages.
Within five (5) years after the establishment and effective operation of the
HTAC, it shall transition into an independent entity separate from the DOH,
attached to DOST.
(d)
The HTAC shall conduct the HTA in accordance with the
principles, criteria and procedures of this Act and ensure that its process is
transparent, conducted with reasonable promptness, and the result of its
deliberations is made public. The HTAC shall consist of a core committee and
subcommittees.
The
core committee, which shall elect from among themselves its Chairperson, shall
be composed of nine (9) voting members, namely: a public health epidemiologist;
a health economist; an ethicist; a citizen’s representative; a sociologist or
anthropologist; a clinical trial or research methods expert; a clinical
epidemiologist or evidence–based medicine expert; a medico–legal expert; and
public health expert.
The
subcommittees to be constituted shall include, among others: Drugs, Vaccines,
Clinical Equipment and Devices, Medical and Surgical Procedure, Preventive and
Promotive Health Services, and Traditional Medicine. Each subcommittee shall
have a minimum of one (1) and maximum of three (3) non– voting members for each
subcommittee.
The
HTAC may call upon technical resource persons from PhilHealth, Food and Drug
Administration (FDA), patient groups and clinical medicine experts as regular
resource persons; and representatives from the private sector and health care
providers as by–invitation resource person.
(e)
The HTAC’s core committee and subcommittee members shall be
appointed by the Secretary of Health for a term of three (3) years except for
the medico–legal expert, ethicist, and the sociologist or anthropologist who
shall serve a term of four (4) years: Provided, that no member shall serve for
more than three (3) consecutive terms: Provided, further, that the members of
the HTAC shall receive an honorarium in accordance with existing policies:
Provided, furthermore, that the DOH shall promulgate the nomination process for
all HTAC members with a clear set of qualifications, credentials and
recommendations form the sectors concerned: Provided, finally, that the
secretary of the DOST shall appoint the members of the HTAC upon its transition
into an attached agency under DOST.
Section 35
Ethics in
Public Health Policy and Practice
(a)
Conflict of interest declaration and management shall be
routine in all policy– determining activities, an applicable to all appointed
decision–makers, policymakers and their staff.
(b)
All manufacturers of drugs, medical devices, biological and
medical supplies registered by the FDA shall collect and track all financial
relationships with health care professionals and health care providers and
report these to the DOH, which shall then make this list publicly available in
accordance with existing laws.
(c)
A public health ethics committee shall be constituted as an
advisory body to the Secretary of Health to ensure compliance with the
provision of this section.
Section 36
Health
Information System
All health
service providers and insurers shall each maintain a health information system
consisting of enterprise resource planning, human resource information,
electronic health records, and an electronic prescription log consistent with
DOH standards, which shall be electronically uploaded on a regular basis
through interoperable systems: Provided, that the health information system
shall be developed and funded by the DOH and PhilHealth: Provided, further,
that patient privacy and confidentiality shall at all times be upheld, in
accordance with the Data Privacy Act of 2012.
Section 37
Appropriations
The amount
necessary to implement this Act shall be sourced from the following:
(a)
Total incremental sin tax collections as provided for in
Republic Act No. 10351, otherwise known as the “Sin Tax Reform Law”: Provided,
that the mandated earmarks as provided for in Republic Act Nos. 7171 and 8240
shall be retained.
(b)
Fifty percent (50%) of the National Government share from the
income of the Philippine Amusement Gaming Corporation (PAGCOR) as provided for
in Presidential Decree No. 1869, as amended: Provided, that the funds raised
for this purpose shall be transferred to PhilHealth at the end of each quarter
subject to the usual budgeting, accounting and auditing rules and regulations:
Provided, further, that the funds shall be used by PhilHealth to improve its
benefit packages.
(c)
Forty percent (40%) of the Charity Fund, net of Documentary
Stamp Tax Payments, and mandatory contributions of the Philippine Charity
Sweepstakes Office (PCSO) as provided for in Republic Act No. 1169, as amended:
Provided, that the funds raised for this purpose shall be transferred to
PhilHealth at the end of each quarter subject to the usual budgeting,
accounting and auditing rules and regulations: Provided, further, that the
funds shall be used by PhilHealth to improve its benefit packages;
(d)
Premium contributions of members;
(e)
Annual appropriations of the DOH included in the GAA; and
(f)
National Government subsidy to PhilHealth included in the GAA
The
amount necessary to implement the provisions of this Act shall be included in
the GAA and shall be appropriated under the DOH and National Government subsidy
to PhilHealth. In addition, the DOH, in coordination with PhilHealth, may
request Congress to appropriate supplemental funding to meet targeted
milestones of this Act.
Section 38
Penal
Provisions
Any violations
of the provisions of this Act, after due notice and hearing, shall suffer the
corresponding penalties as herein provided:
(a)
A health care provider of population–based health services who
violates any of the provision in its respective contract shall be subject to
sanctions and penalties under its respective contracts without prejudice to the
right of the government to institute any criminal or civil action before the
proper judicial body.
(b)
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 Two hundred thousand pesos (P200,000.00) for
each count, or suspension of contract up to three (3) months or the remaining
period of its contract or accreditation whichever is shorter, or both, at the
direction of the PhilHealth, taking into consideration the gravity of the
offense.
The
same shall also constitute a criminal violation punishable by imprisonment for
six (6) years, upon discretion of the court without prejudice to criminal
liability defined under the Revised Penal Code.
If
the health care provider is a juridical person, its officers and employees or
other representatives found to be responsible, who acted negligently or with
intent, or have directly or indirectly caused the commission of the violation,
shall be liable. Recidivists may no longer be contracted as participants of the
Program.
(c)
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 Fifty
thousand pesos (P50,000.00) for each count or suspension from availment of the
benefits of the Program for not less than three (3) months but not more than
six (6) months, or both, at the discretion of PhilHealth.
(d)
Any employer who:
(1)
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 Fifty thousand pesos (P50,000.00) for every
violation per affected employee, or imprisonment of not less than six (6)
months but not more than one (1) year, or both such fine and imprisonment, at
the discretion of the court.
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 thirty (30) days from due date
shall be presumed prima facie, 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.
If
the employer is a juridical person, its officers and employees or other
representatives found to be responsible, whether they acted negligently or with
intent, or have directly or indirectly caused the commission of the violation,
shall be liable.
(2)
Deducts, directly or indirectly, from the compensation of the
covered employees or otherwise recover from the employer’s own contribution on
behalf of such employees shall be punished with a fine of Five Thousand pesos
(P5,000.00) multiplied by the total number of affected employees or
imprisonment of not less than six (6) months but not more than one (1) year, or
both such fine and imprisonment, at the discretion of the court.
If
the unlawful deduction is committed by an association, partnership, corporation
or any other institution, its managing directors or partners or president or
general manager, or other persons responsible for the commission of the act
shall be liable for the penalties provided for in this Act.
(e)
Any director, officer or employee of PhilHealth who:
(1)
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 misappropriation of funds under this Act and shall be
punished with a fine equivalent to triple the amount misappropriated per count
and suspension for three (3) months without pay.
(2)
Commits an unethical act, abuse of authority, or performs a
fraudulent act shall be punished by a fine of Two hundred thousand pesos
(P200,000.00) or suspension for three (3) months without pay, or both, 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 six (6) months and one (1) day up to six (6) years, upon discretion of the
court without prejudice to criminal liability defined under the Revised Penal
Code.
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 Five
thousand pesos (P5,000.00) but not more than Twenty thousand pesos
(P20,000.00).
All
other violations involving funds of PhilHealth shall be governed by the
applicable provisions of the Revised Penal Code or other laws, taking into
consideration the rules on collection, remittances, and investment of funds as
may be promulgated by PhilHealth.
PhilHealth
may enumerate circumstances that will mitigate or aggravate the liability of
the offender or erring health care provider, member or employer.
Despite
the cessation of operation by a health care provider or termination of practice
of an independent health care professional while the complaint is being hear,
the proceeding shall continue until the resolution of the case.
Section 39
Oversight
Provision
There is hereby
created a Joint Congressional Oversight Committee on Universal Health Care to
conduct a regular review of the implementation of this Act which shall entail a
systematic evaluation of the performance, impact or accomplishments of this Act
and the performance of the various agencies involved in realizing universal
health care, particularly with respect to their roles and functions.
The Joint
Congressional Oversight Committee shall be jointly chaired by the Chairperson
of the Senate Committee on Health and Demography and the House of
Representatives Committee on Health. It shall be composed of five (5) members
from the Senate and five (5) members from the House of Representatives, to be
appointed by the Senate President and the Speaker of the House of
Representatives, respectively.
The National
Economic and Development Authority, in coordination with the PSA, National
Institute of Health, and other academic institutions shall undertake studies to
validate and evaluate the accomplishments of this Act. These validation studies
and annual reports, on the performance of the DOH and PhilHealth shall be
submitted to the Joint Congressional Oversight Committee.
The DOH and
PhilHealth shall allocate an adequate funding for the purpose of conducting
these studies.
The Joint
Congressional Oversight Committee shall commission an independent study to
evaluate the implementation of this Act.
Section 40
Performance
Monitoring Division
The DOH shall
establish a Performance Monitoring Division to monitor and evaluate the proper
and effective implementation of the provision of this Act. The office in charge
of field implementation performance of the DOH shall be augmented by the DOH
Secretary, as may be deemed necessary.
Section 41
Transitory
Provision
(a)
Within thirty (30) days from the effectivity of this Act, the
President of the Philippines shall appoint the new members of the Board and the
President of PhilHealth. The existing board of directors shall serve in a
hold–over capacity until a full and permanent board of directors of PhilHealth
is constituted and functioning.
(b)
All officers and personnel of PhilHealth, except members of
the Board who shall be governed by the first paragraph of this section, shall
continue to perform their duties and responsibilities and receive their
corresponding salaries and benefits. The approval of this Act shall not cause
any demotion in rank or diminution of salary, benefits and other privileges of
the incumbent personnel of PhilHealth: Provided, that qualified officers and
personnel may voluntarily elect for retirement or separation from service and
shall be entitled to the benefits under existing laws.
(c)
All affected officers and personnel of the PCSO shall be
absorbed by the agency without demotion in rank or diminution of salary,
benefits and other privileges: Provided, that qualified officers and personnel
of the agency may voluntarily elect for retirement or separation from service
based on PCSO Board–approved Early Retirement Incentive Program (ERIP),
utilizing internally–generated funds, or savings form its operating fund:
Provided, finally, that the retirement benefit package shall be reasonable and
within the bounds of existing laws.
(d)
In the first six (6) years from the enactment of this Act, the
National Government shall provide technical and financial support to selected
LGUs that commit to province–wide integration, subject to further review after
the lapse of six (6) years: Provided, that in the first three (3) years
thereafter, the province–wide and city–wide systems shall exhibit financial
integration: Provided, finally, that upon positive recommendation by an
independent study commissioned by Joint Congressional Oversight Committee on
Universal Health Care of the overall benefit of province–wide integration and
the positive recommendation of the Secretary of Health, all local health
systems shall be integrated as prescribed by Section 19 of this Act through the
issuance of an Executive Order by the President.
(e)
In the first ten (10) years from the enactment of this Act,
PhilHealth may outsource certain functions to ensure operational efficiency and
towards the fulfillment of this Act: Provided, that any outsourcing shall
comply with the provisions of Republic Act No. 9184, otherwise known as the
“Government Procurement Reform Act,” and its IRR.
(f)
In the first three (3) years from the enactment of this Act,
PhilHealth and DOH shall provide reasonable financial and licensing incentives
to contracted health care facilities to form health care provider networks.
Thereafter, these incentives shall be withdrawn and providers shall be fully
subject to the provisions of Section 19 of this Act.
(g)
The HTAC under the DOH shall be established within one (1)
year from the effectivity of this Act: Provided, that the existing health
benefit package shall be rationalized within two (2) years from the
establishment of the HTAC.
(h)
Within three (3) years form the effectivity of this Act, all
private insurance companies and HMOs together with DOH and PhilHealth, shall
have developed a system of co–payment that complements PhilHealth benefit
packages.
(i)
Within ten (10) years from the effectivity of this Act, only
those who have been certified by the DOH and PRC to be capable of providing
primary care will be eligible to be a primary care provider.
(j)
For the first two (2) years from the effectivity of this Act,
the PCSO shall transfer at least fifity percent (50%) of the forty percent
(40%) of the charity fund per year, in accordance with Section 37(c) of this
Act, to enable the PCSO to conclude and liquidate its Individual Medical
Assistance Program At Source–ang–Processing (IMAP–ASAP) obligations.
Section 42
Interpretation
All doubts in
the implementation and interpretation of this Act, including its IRR, shall be
resolved in favor of upholding the rights interests of every Filipino to
quality, accessible and affordable health care.
Nothing in this
Act shall be construed to eliminate or in any way diminish Program benefits
being enjoyed at the time of promulgation of this Act.
Section 43
Implementing
Rules and Regulations (IRR)
The DOH and the
PhilHealth, in consultation and coordination with appropriate national
government agencies, civil society organizations, nongovernment organizations,
private sector representatives, and other stakeholders, shall promulgate the
necessary rules and regulations for the effective implementation of this Act no
later than one hundred eighty (180) days upon the effectivity of this Act.
Section 44
Separability
Clause
If any part or
provision of this Act is held invalid or unconstitutional, the remaining parts
or provisions not affected shall remain in full force and effect.
Section 45
Repealing
Clause
The pertinent
provisions of the following laws are hereby amended accordingly:
(a)
Section 6,7,10, 12, 16(n), 18, 19, 25, 26, 27, 28, 44, 45, 46,
47, 48 and 54 of Republic Act No. 7875, otherwise known as the “National Health
Insurance Act of 1995”,as amended by Republic Act No. 9241 and Republic Act No.
10606;
(b)
Section 8(c) of Republic Act No. 10351, otherwise known as the
“Sin Tax Reform Law”;
(c)
Presidential Decree No. 1869, otherwise known as the PAGCOR
Charter, as amended; and
(d)
Republic Act No. 1169, otherwise known as the PCSO Charter, as
amended, with respect to the provision of Section 37 of this Act.
All other laws,
decrees, executive orders and rules and regulations contrary to or inconsistent
with the provisions of this Act are hereby repealed or amended accordingly.
Section 46
Effectivity
This Act shall
take effect fifteen (15) days after its publication in the Official Gazette or
in any newspaper of general circulation.
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