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Development Team Headed by Undersecretary Mario C

The document discusses the Universal Health Care Act in the Philippines and its goal of providing affordable, quality healthcare to all Filipinos. It outlines reforms like establishing healthcare provider networks with primary, secondary, and tertiary levels of care. It also discusses expanding coverage, establishing mechanisms for affordability and equity, and ensuring adequate health workforce and resources.

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24 views2 pages

Development Team Headed by Undersecretary Mario C

The document discusses the Universal Health Care Act in the Philippines and its goal of providing affordable, quality healthcare to all Filipinos. It outlines reforms like establishing healthcare provider networks with primary, secondary, and tertiary levels of care. It also discusses expanding coverage, establishing mechanisms for affordability and equity, and ensuring adequate health workforce and resources.

Uploaded by

drrmhmanila1
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Development Team headed by Undersecretary Mario C. Villaverde for developing this book.

I am
optimistic that their unparalleled effort will immensely contribute to the implementation of Republic Act
No. 11223 or the Universal Health Care (UHC) Act. This book will be a valuable reference for health
managers, health care implementers, and other stakeholders as we continue our journey towards
attaining UHC. I once said that the UHC Act had laid out our North Star. It is actually an opportunity for
us to reorganize our health system, with primary health care as the foundation. The law targets the
provision of the full range of high quality health care services at affordable cost to all Filipinos. It enables
the health system to slowly shift from its current hospital-oriented approach towards a health promotion
and disease prevention paradigm. The UHC Act has a lot in store for every Juan and Juana. For starters,
health care provider networks with referral mechanisms from primary to tertiary levels of care will be
established. In the public sector, local health systems will be integrated into province-wide and city-wide
health systems in order to strengthen coordination and address the gaps in our devolved health system.
Investments for health will be harmonized to ensure proper complementation of efforts among DOH,
PhilHealth, LGUs, and the private sector towards improved health system functions and health service
delivery. Following the stipulation in the law, every Filipino will have a designated primary care provider.
As the basic foundation of health care provider networks, primary care providers will be organized to: (1)
be the first point of contact in the health care system; (2) provide essential health services at the least
cost possible, if not free at the point of service; and (3) navigate xvi Universal Health Care in the
Philippines: From Policy to Practice patients within the health system as they access higher levels of care.
With the built-in coordination and referral mechanisms of such networks, health service delivery will be
rationalized, and unnecessary hospitalization will be avoided. To ensure quality of care, the scope of DOH
regulation is now expanded to cover primary care facilities. Aside from ensuring the safety and quality of
health goods and services, mechanisms that would bring about affordability and equity are now being
established. These efforts are complemented by the establishment of mechanisms that ensure better
flow of health and health-related information from public and private sources. Under the UHC Act, all
Filipinos are deemed members of the National Health Insurance Program under a simplified membership
categorization – either direct or indirect contributory members. Each member is immediately eligible to
avail of a comprehensive set of essential benefit packages. These packages span the entire spectrum
from health promotion and disease prevention, to curative, rehabilitative and palliative aspects of the
continuum of care. The no balance billing policy will be shifted to no co-payment policy, shifting coverage
from indigents only to all Filipinos. Provided, that they are admitted to basic or ward accommodations.
Along this line, hospitals are also expected to allot beds exclusively for basic or ward accommodation.
PhilHealth will be the national purchaser of individual-based health services. Simply put, funds intended
for inpatient and outpatient medical and surgical services will be pooled into PhilHealth. This will ensure
adequate negotiating power to lower the cost of health care and improve the quality of services. On the
other hand, population-based health services such as disease surveillance, health promotion, and
disaster risk reduction and management in health will now be financed by DOH in complementation with
local budget. Recognizing the importance of human resources for health (HRH) in all levels of the health
system, the UHC Act establishes mechanisms that ensure adequate health workforce. Along this line, a
support system to assist LGUs in their HRH needs is being created. Interventions to ensure continuous
availability of health professionals are already being established. These include expansion of health-
related degrees and training programs, and return service mechanism for government-funded scholars.
xvii Francisco T. Duque III, MD, MSc Secretary of Health We hope that through this book, which serves as
a reference material to the series of UHC online modules accessible in the DOH Academy, we will be able
to level off understanding of the law and work in unison towards: (1) progressively realizing UHC 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 (2) ensuring that all Filipinos are guaranteed
equitable access to quality and affordable health care goods and services, and protected against financial
risk. Finally, let me assure you that we remain committed to be inclusive and participatory in making UHC
a reality. We will continuously find innovative ways to create avenues for learning, like this book. Let us
all be mindful that the success of UHC can only be measured through the well-being of every Juan and
Juana and how well our health systems respond to their health needs. I therefore call on each and
everyone to help us bridge potential gaps in UHC implementation though effective collaboration and
partnerships. xviii Universal Health Care in the Philippines: From Policy to Practice 1 Framework and
Mandates of Universal Health Care in the Philippines Chapter I The Universal Health Care (UHC) Act, also
known as Republic Act 11223, was signed into law by President Rodrigo Roa Duterte on February 20,
2019. Its Implementing Rules and Regulations was signed by Health Secretary Francisco T. Duque III on
October 10, 2019, thus paving the way for the Philippines to embark on a major health reform under the
leadership of the Department of Health (DOH) and the Philippine Health Insurance Corporation
(PhilHealth). The conceptual framework of the law is based on the World Health Organization’s three
dimensions of universal health coverage, namely population coverage, service coverage, and financial
coverage. The law mandated major areas of reform in the health sector, such as the organization of the
health system into health care provider networks composed of primary, secondary and tertiary levels of
care where primary care facilities serve as the gatekeeper and navigator of health services within the
network; the classification of health services into two 2 Universal Health Care in the Philippines: From
Policy to Practice major groups of health care packages consisting o

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