Republic of the Philippines

PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY

(Formerly Ramon Magsaysay Technological University)
Iba, Zambales, Philippines
Tel/Fax No.: (047) 811 1683
- GRADUATE SCHOOL –
MAED MAJOR IN EDUCATIONAL ADMINISTRATION

Legal Aspects of Education

UNIVERSAL HEALTH CARE ACT

Rhea B. Reyman
Discussant

Dr. Renato Ruba

Professional Lecturer

Reported last July 11, 2020

What is Republic Act 11223?

RA 11223 also known as “Universal Health Care (UHC) Act”, also referred to as
Kalusugan Pangkalahatan (KP),was approved by our president Rodrigo Roa Duterte last
February 20, 2019. The main goal is to automatically enrolls all Filipino citizens in the National
Health Insurance Program and prescribes complementary reforms in the health system.

This gives citizens access to the full continuum of health services they need, while protecting
them from enduring financial hardship as a result. It is a government mandate aiming to ensure
that every Filipino shall receive affordable and quality health benefits. This involves providing
adequate resources – health human resources, health facilities, and health financing.

UHC THREE THRUSTS

To attain UHC, three strategic thrusts are to be pursued, namely: 1) Financial risk protection
through expansion in enrollment and benefit delivery of the National Health Insurance Program
(NHIP); 2) Improved access to quality hospitals and health care facilities; and 3) Attainment of
health-related Millennium Development Goals (MDGs).

1. Financial Risk Protection

Protection from the financial impacts of health care is attained by making any Filipino eligible to
enroll, to know their entitlements and responsibilities, to avail of health services, and to be
reimbursed by PhilHealth with regard to health care expenditures.

PhilHealth operations are to be redirected towards enhancing national and regional health
insurance system. The NHIP enrollment shall be rapidly expanded to improve population
coverage. The availment of outpatient and inpatient services shall be intensively promoted.
Moreover, the use of information technology shall be maximized to speed up PhilHealth claims
processing.

2. Improved Access to Quality Hospitals and Health Care Facilities

Improved access to quality hospitals and health facilities shall be achieved in a number of
creative approaches. First, the quality of government-owned and operated hospitals and health
facilities is to be upgraded to accommodate larger capacity, to attend to all types of emergencies,
and to handle non-communicable diseases. The Health Facility Enhancement Program (HFEP)
shall provide funds to improve facility preparedness for trauma and other emergencies. The aim
of HFEP was to upgrade 20% of DOH-retained hospitals, 46% of provincial hospitals, 46% of
district hospitals, and 51% of rural health units (RHUs) by end of 2011.
 Financial efforts shall be provided to allow immediate rehabilitation and construction of critical
health facilities. In addition to that, treatment packs for hypertension and diabetes shall be
obtained and distributed to RHUs.

The DOH licensure and PhilHealth accreditation for hospitals and health facilities shall be
streamlined and unified.

3. Attainment of Health-related MDGs

Further efforts and additional resources are to be applied on public health programs to reduce
maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and
incidence of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as
the prevention and control of non-communicable diseases.

The organization of Community Health Teams (CHTs) in each priority population area is one
way to achieve health-related MDGs. CHTs are groups of volunteers, who will assist families
with their health needs, provide health information, and facilitate communication with other
health providers. RNheals nurses will be trained to become trainers and supervisors to coordinate
with community-level workers and CHTs. By the end of 2011, it is targeted that there will be
20,000 CHTs and 10,000 RNheals.

Another effort will be the provision of necessary services using the life cycle approach. These
services include family planning, ante-natal care, delivery in health facilities, newborn care, and
the Garantisadong Pambata package.

Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG,
would also be essential for the achievement of these MDGs.

8 Things to Know

1. ALL Filipinos are covered

Every single Filipino citizen is automatically enrolled into the newly-created National Health Insurance
Program (NHIP). The program classified membership into two types:

 Direct contributors – those who pay PhilHealth premiums, are employed and bound by an
"employer-employee relationship," self-earning, professional practitioners, and migrant workers.
Members’ qualified dependents and lifetime members are also included.
 Indirect contributors – those not considered as direct contributors, along with their qualified
dependents, whose health premiums are subsidized by the government
All Filipinos will be granted “immediate eligibility” and access to the full spectrum of health care which
includes preventive, promotive, curative, rehabilitative, and palliative care. This can be expected for
medical, dental, mental, and emergency health services.

Filipinos will also be enrolled with a primary health care provider of their choice. The primary care
provider is the health worker they can go and seek treatment from for health concerns. They will also
serve as the person in charge of referring and coordinating with other health centers if patients need
further treatment.

Citizens will not need to present any PhilHealth ID to avail of these benefits. Meanwhile, poor Filipinos
or those who are located in geographically isolated areas will also be given priority when ensuring access
to health services.

2. It is not completely free

Contrary to what some people may think, UHC does not mean every single health expense will be made
free.

The law outlines that basic services accommodations will be covered by PhilHealth.

As a patient, that means that if you’re admitted in a hospital you can expect regular meals, a bed in a
shared room with fan ventilation, and a shared toilet and bath to be covered.

All are also entitled to an “essential health benefit package,” which includes primary care, medicines,
diagnostic, and laboratory tests. It also includes preventive, curative, and rehabilitative services.

It will no longer be free when one wants to stay in a hospital room offering private accommodation, air
conditioning, telephone, television, and meal choices, among others.

Meanwhile, public and private hospitals are expected to allocate a certain portion of their beds as basic
accommodations in the following amounts:

 Government hospitals – at least 90% of beds

 Specialty hospitals – at least 70% of beds
 Private hospitals – at least 10% of beds

As long as a patient avails of these basic accommodations, it will be covered by PhilHealth whether in a
public or private hospital.

The law also states that if patients need to pay for extra expenses, their “co-payment” – or what is paid on
top of basic services – should be regulated by the DOH in public hospitals. This means that you should
know what to expect in terms of bills, as opposed to being shocked after treatment.
Aside from this, current case rates or packages PhilHealth has crafted for certain diseases will remain. But
together with the DOH, PhilHealth is expected to work towards including more needs a person may have
for a disease in its case rates.

The two agencies are also expected to craft and implement outpatient benefit services to be covered by
the National Health Insurance Programs within 2 years after the law takes effect.

3. PhilHealth will become the “national purchaser” of health goods and services

This means that PhilHealth will be in charge of paying health care providers like hospitals and clinics for
services given to Filipinos. This is already a job PhilHealth carries out but the universal health care law
wants to pool more funds so it can cover all Filipinos and eventually, more services.

Allocating more funds to PhilHealth will also strengthen its negotiating power with health care providers,
which will foreseeably improve the quality of services and lower health costs.

Funds for PhilHealth will be sourced from the following:

 Philippine Amusement and Gaming Corporation – 50% of national government’s share

 Philippine Charity Sweepstakes Office (PCSO) – 40% of its charity fund, net of document stamp
tax payments, and mandatory PCSO contributions
 Premium contributions of direct contributory members
 PhilHealth annual budget

With multiple fund sources for PhilHealth, Filipinos will no longer need to troop to various government
offices to secure funds to pay for health expenses. It will also make them less dependent on politicians to
help pay for health services.

By giving PhilHealth more funds, a goal of the UHC is to make PhilHealth the national purchaser of
medicines. This can lower the cost of medicines as these will be bought in bulk.

Another goals is to have quality of health services improve as PhilHealth can set as a requirement for
payment and contracting, standards for health care providers.

4. DOH will still be in charge of “population-based” health services

While PhilHealth, along with other private health insurance companies, is expected to cover services for
individuals, the DOH is still in charge of delivering health services that cover entire populations.

Think of these as programs for disease surveillance, health promotion campaigns, and mass immunization
campaigns.

The DOH will do this by contracting public health care providers in cities and provinces.

5. Health systems will become city-wide and province-wide

Provinces and highly urbanized cities will now be in charge of overseeing health services in areas as
opposed to the current set-up where municipalities are tasked with managing their own health centers.

The DOH will need to work with the Department of the Interior and Local Government (DILG) to have
province- and city-wide health systems or networks in about two years after the law takes affect.

For this, one can imagine as an example, Rizal overseeing its province-wide health care network of
clinics and hospitals compared to each municipality in Rizal taking care of its own health center alone.
Similarly, highly urbanized cities like Cebu or Makati will oversee their own health care network
compared to single barangays being in charge of a health center.

Having access to health networks province-wide can address the problem of inadequae access to health
services due to lack of funds in barangays or municipalities.

Provincial and city health boards will be in charge of pooling and managing a special health fund to
finance and improve health services for residents. PhilHealth’s income will also be channeled to this
special health fund.

6. Return service in the public health sector

Graduates of health and health-related courses who received government-funded scholarships will be
required to work in the public health sector for at least 3 full years. This will address the need for health
workers across the country.

They will be paid by and under the supervision of the DOH. Those who serve for an extra two years will
also be given incentives, which will be determined by the DOH.

Meanwhile, graduates of health courses in state universities and colleges and private schools are
encouraged to work in the public sector.

7. A “Health Technology and Assessment Council” (HTAC) will be created

Another important feature of the law is the creation of the HTAC – a group of health experts who will be
responsible for evaluating latest health developments and recommending their use to DOH and
PhilHealth.

The HTAC will be responsible for assessing the safety and effectiveness of health technology, devices,
medicines, vaccines, health procedures, and other health-related advances developed to solve health
problems.

Reviewing the social, economic, and ethical issues when using these technologies or programs is also
required.
The HTAC will be attached to the DOH for the first 5 years after the law is implemented. After this, it
will become an independent body attached to the Department of Science and Technology.

8. Health information will be collected

Both public and private hospitals and health insurers will be required to maintain a health information
system that will contain electronic health records, prescription logs, and “human resource information.”

This system will be developed and funded by DOH and PhilHealth. It will also be subject to patient
confidentiality rules and data privacy laws.