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Seventeenth Congress
Third Regular Session

Begun and held in Metro Manila, on Monday, the twenty-third day of July, two thousand eighteen.

REPUBLIC ACT No. 11223

An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System,
and Appropriating Funds Therefor

Be it enacted by the Senate and House of Representatives of the Philippine Congress Assembled:

CHAPTER 1

GENERAL PROVISIONS

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
hardship,, 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 loss
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 includes 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 the part of the doer or any means that deviate from normal procedure and is undertaken for personal gam,
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
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 impact
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 traced back to one (1) recipient, has limited effect at a 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 referrals 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 institution 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
persons profession or practice, or other similar, analogous acts that put or tend to put in disrepute the integrity
and effective implementation of the NHIP.

CHAPTER II
UNIVERSAL HEALTH CARE (UHC)

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 be 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.

CHAPTER III
NATIONAL HEALTH INSURANCE PROGRAM

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 benefit 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 expenditures as reserve funds: Provided, That the total amount of reserves
shall not exceed a 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
abovementioned 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 earnings 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
Bangko Sentral ng Pilipinas;

(d) In preferred stocks of any solvent corporation or institution 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 earnings 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 institution 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 -controlled corporations.

As part of its investments operations, PhilHealth may hire institutions with valid trust licenses 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 executives 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.

(b) The Secretary of Health shall be an ex officio nonvoting Chairperson of the Board.

(c) 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 a ground for
dismissal.

Within thirty (30) days following the effectivity of this Act, the Governance Commission for Government-Owned or -
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 recommendation from the concerned sectors.

Section 14. President and Chief Executive Officer (CEO) of PhilHealth. - Upon the 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 of these 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 retirement 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.

CHAPTER IV
HEALTH SERVICES DELIVERY

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:

(a) Primary care provider network with patient records accessible throughout the health system;

(b) Accurate, sensitive, and timely epidemiologic surveillance systems; and

(c) 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-payment/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.

CHAPTER V
ORGANIZATION OF LOCAL HEALTH SYSTEMS

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 Boards shall
oversee and coordinate the integration of health services for province-wide and city-wide 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 Boards 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 the 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 underserved and unserved areas shall be given priority in the allocation of
grants: Provided, further, That the grants shall be 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 or private health sector investments.

CHAPTER VI
HUMAN RESOURCES FOR HEALTH

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 of 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 encouraged 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.

CHAPTER VII
REGULATION

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) 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
sourced 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 negotiation 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 services 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 then’
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 then bed capacity as basic or ward accommodation: Provided, further, That private
hospitals are required to operate not less than ten percent (10%) of then 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.

CHAPTER VIII
GOVERNANCE AND ACCOUNTABILITY

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 Healthy 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 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 glob ally-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 and 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 of 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 fan’ 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, farther, 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 provision 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; and (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 a 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 the 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 persons.

(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 for 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 from 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. - The implementation of UHC shall be strengthened by
commitment of all stakeholders to abide by ethical principles in public health practice:

(a) Conflict of interest declaration and management shall be routine in all policy-determining activities, and
applicable to all appointed decision-makers, policymakers and then 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.

CHAPTER IX
APPROPRIATIONS

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.

CHAPTER X
PENAL PROVISIONS

Section 38. Penal Provisions. - Any violation 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 (₱200,000.00) 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 discretion 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) 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.

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 (₱50,000.00) 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 (₱50,000.00) 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. 1âwphi1

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 them the employer’s own contribution on behalf of such employees shall be punished with
a fine of Five thousand pesos (₱5,000.00) 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 (₱200,000.00) 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 (₱5,000.00) but not more than Twenty thousand
pesos (₱20,000.00).

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 heard, the proceeding shall continue until the resolution
of the case.

CHAPTER XI
MISCELLANEOUS PROVISIONS

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 Chairpersons 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 Institutes 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 provisions of this Act. The office in charge of
field implementation performance of the DOH shall comprise the core personnel of the office which 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. 1âwphi1

(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 from 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 from the enactment of this Act, the
province-wide and city-wide systems shall exhibit managerial integration: Provided, further, That within the
: