Universal Health Care Act
DEPARTMENT OF HEALTH – CENTER FOR HEALTH DEVELOPMENT CaLaBaRZon
The Universal Health Care Act
1.1 Situationer
1.2 The UHC Act and Its Underpinnings
1.3 A Systemic Approach to UHC
1.4 UHC in a Nutshell
Department of Health, Philippines
Universal
Health Care
Act
1.1 Situationer
Philippines remain deeply underserved
Average Life Maternal Under 5 TB Incidence
Ranking
Expectancy Mortality Ratio Mortality Rate Rate
1st (BEST) Singapore Singapore Singapore Brunei
2nd Brunei Thailand Malaysia Singapore
3rd Vietnam Brunei Brunei Malaysia
4th Malaysia Malaysia Thailand Vietnam
5th Thailand Vietnam Vietnam Thailand
6th Indonesia Philippines Indonesia Laos
7th Philippines Indonesia Philippines Cambodia
8th Cambodia Cambodia Cambodia Myanmar
9th Myanmar Myanmar Myanmar Indonesia
10Department
th of Health, Philippines
POLICY BOTTLENECKS
that limit trajectory for UHC.
Limited recognition of primary health care
and coverage of primary care services
< 20% of health spending 74% of Filipinos First study on
allocated to primary and bypass health centers health literacy ongoing
preventive care
Department of Health, Philippines
POLICY BOTTLENECKS
that limit trajectory for UHC.
Highly unregulated public and private health care market
Private health insurance 22% of plantilla positions
Uncontrolled balance market is not leveraged in public health sector
billing by providers despite fast growth unfilled
Department of Health, Philippines
POLICY BOTTLENECKS
that limit trajectory for UHC.
Lack of clarity in roles and transparency in data
Overlaps in Unclear Only 55% of Rural Average PhilHealth
financing and prioritization Health Units use e-claims compliance
service delivery mechanism for Electronic Medical of hospitals is 35-
roles services to be Records 46%
funded
Department of Health, Philippines
Universal
Health Care
Act
1.2. The UHC Law and
Its Underpinnings
Evolution of the Various Versions
HB 5784 SB 1869
(Tan et al) (Recto et al)
HB 225 SB 60
(Roque) (Recto)
Bicameral Committee
HB 5120 SB 1458
(Salo) ( Ejercito)
Ratification
HB 1975 SB 1714 SB 1673
(Hontiveros) (Angara)
(Santos- Recto)
Signed into Law
Department of Health, Philippines
RA 11223: Universal Health Care Act
GENERAL OBJECTIVES
● To ensure equitable access to quality and affordable health care and
protection against financial risk
● To progressively realize universal health care through systemic
approach and clear role delineation
Department of Health, Philippines
RA 11223: Universal Health Care Act
GENERAL OBJECTIVES
● To ensure equitable access to quality and affordable health care and
protection against financial risk
● To progressively realize universal health care through systemic
approach and clear role delineation
Coordinated, not piecemeal
“band-aid”
Department of Health, Philippines
RA 11223: Universal Health Care Act
GENERAL OBJECTIVES
● To ensure equitable access to quality and affordable health care and
protection against financial risk
● To progressively realize universal health care through systemic
approach and clear role delineation
Coordinated, not piecemeal Know our role to
“band-aid” play our part well
Department of Health, Philippines
RA 11223: Universal Health Care Act
DECLARATION OF PRINCIPLES
● Integrated and comprehensive approach to healthy living
conditions
● Whole-of-system, whole-of-government, whole-of-society
approach in the development of health policies
● People-oriented approach centered on people’s needs and well-
being
Department of Health, Philippines
Department of Health, Philippines
Universal Health Care means…
✔ healthy living, schooling ✔ primary care provider ✔ health spending is
& working environments team for every family predictable, not “lahat libre”
✔ care is provided for by providers organized as
INTEGRATED NETWORKS
Department of Health, Philippines
Universal Health Care
does not mean “lahat libre”
Every Filipino family is matched to a Every Filipino family’s health spending
primary care team, who ensures that they is predictable; PhilHealth ensures they
get the appropriate services they need are protected from financial risk
in the appropriate facility
Department of Health, Philippines
Universal
Health Care
Act 1.2. A “Systematic”
Approach to UHC
Financing ✭ Service Delivery ✭ Regulation ✭
Governance
(1) Financing
A. Defining roles B. Simplifying C. Pooling funds to
PhilHealth PhilHealth
membership
Department of Health, Philippines
POOLING OF Fund Pooling in UHC
FUNDS TO PHIC
C CURRENT POLICY
DOH
UHC
PAGCOR
PCSO
DOH
DSWD
Others
PHIC
PAGCOR PHIC
PCSO
DSWD
Others
• Redundant, fragmented • Clear delineation, pooling to efficiently
• Low premium mobilize existing funds
• Multiple purchasers >> smaller pools, less • Higher premium
leverage, weak power to influence prices of • Single purchaser >> No overlaps, more
goods and services powerful negotiation and price control
Department of Health, Philippines
Service Delivery
A.Contracting by B. Consolidating C. Improving D. Securing resources
network and and retaining income for
public system into pool, presence, health through a special
designating primary care
providers* as
province-wide and perspective of health fund
navigators city-wide health HCWs
systems
Department of Health, Philippines
A Contracting by
Network Pathway of Patient Enlisted in a Network
HOSPITAL
HOSPITAL
Charge toCharge
networkto network
(PUBLIC/PRIVATE)
(PUBLIC/PRIVATE)
SPECIALIZED
APEX
TERTIARY CARE
END REFERRAL
PRIMARY
PRIMARY
CARE CARE SPECIALIST
+ ANCILLARY
+ ANCILLARY SPECIALIST
OUTPATIENT
+ PHARMACY+ PHARMACY OUTPATIENT
(P250 – P300)
+/- Population-based
+/- Population-based
services services
HEALTHY SICK
NON-EMERGENCY HEALTHY
SICK NON-EMERGENCY
SICK EMERGENCY
SICK EMERGENCY
Additional ENLISTED IN NETWORK
reimbursement from
PHIC using DRG
B Integrating Local
Health Systems Dimensions of Integration
A. Technical Integration B. Managerial Integration C. Financial Integration
Encompasses the clinical and public Consolidated administration and Consolidating all financial resources
health functions to deliver seamless, management of public resources at the within a province-wide/city-wide health
coordinated, comprehensive primary province-wide/city-wide level: Human system in a Special Health Fund,
health care with intersectoral resources for health, health facilities and exclusively and strategically used for
participation
equipment, health information system, health and health-related needs.
health technologies and medicines
Department of Health, Philippines
SOURCING
RESOURCES Special Health Fund
D • Province-wide and City-wide Health System
shall pool and manage all resources in order to
finance population-based and individual-based
health services
• DOH, in consultation with DBM and LGUs,
shall develop guidelines for Special Health Fund
• PhilHealth payments shall accrue to the Special
Health Fund and credited as Annual Regular
Income (ARI) of the LGU
Department of Health, Philippines
D Sourcing Resources Proposed Special Health Fund
Provincial / LIPH
City Budget Population-based Individual-based
services services Apex Hospital
DOH Financial PhilHealth Pooled Individual-based
Grants Funds services
Appropriation MOA Private Providers
Ordinance
Provincial / City SHF MOA
Budget for Health Non-Network
ODA, NGO, FBO Providers
Population-based services, human Financial Grants/
resources fees, and operating costs WFP, Allocation guidelines Donations
Operations and
Population-based and Remuneration for Additional
Maintenance of Health Health Systems
Individual-based Health Workers and Incentives Health Research
Offices, Facilities and Operating Costs
Health Services for All Health Workers
Services
Department of Health, Philippines
Regulation
A. Regulating coverage B. Requiring C. Setting standards for D. Licensing for stand-
so co-payment for health transparent pricing clinical practice through alone
services outside basic the development, health facilities,
accommodation is
of health goods and ambulatory, and PCP,
appraisal, and use of
predictable services CPGs and registry of health
care providers
Department of Health, Philippines
Governance
A. Allocating B. Mandating C. Mandatory use D. Promoting
funding and scaling Health Impact of IT systems and fairness and
up Health Assessment for all submission of transparency in
Promotion programs, policies, health and benefits expansion
initiatives and projects financial data by through Health
healthcare Technology
providers and Assessment
Department of Health, Philippines
suppliers
SCALING UP HEALTH
PROMOTION Health Promotion
A • Transformation of the Health Promotion and
Communication Service to Health Promotion
Bureau
• At least one percent (1%) of total DOH budget
earmarked for health promotion program
• DepEd schools to be designated as healthy settings
• Incorporation of health promotion in school
curricula
• LGU to enact stricter ordinances to promote health
literacy and healthy lifestyle
Department of Health, Philippines
Universal
Health Care
Act
2.4. UHC in a Nutshell
Begin with these ENDS in mind.
Universal Health Care is all about...
Service Coverage
- immediate eligibility
Population Coverage - Financial Coverage
and access
automatic inclusion of - Zero co-payment
- comprehensive
every Filipino citizen - Fixed, predictable co-
outpatient benefit
into the NHIP payment
- provision of primary
care provider
Department of Health, Philippines
It means everyone wins!
Payers (private insurers, governments, or self-pay
Filipinos/Patients are health literate,
individuals) able to shape provider behavior
practice healthy lifestyle, live in low-risk
towards quality and efficiency
environments, receive effective care
without financial hardship
Health Care Workers earn decent Providers earn a positive margin for
predictable income and able to pursue producing good outcomes at low cost
career paths
Suppliers of drugs, devices, and diagnostic tests that improve outcomes and/or lower total costs find
their products incorporated into treatment protocols used and reimbursed
Department of Health, Philippines
UHC for Local Government Units
Health Problems in the LGU
Maternal, Infant, and 1 out of 3 Children are Very low immunization People still pay as
Child Diseases/ Deaths stunted due to lack of rates much as half of their
are still high in our nutrition health bills.
localities
Department of Health, Philippines
Health Problems in the LGU
More Filipinos are More than half of Lack of Doctors, Public Hospitals
pushed to poverty due indigent families still Nurses, Midwives, and remain overcrowded
to High Healthcare pay Health Care Bills other Health Workers
Cost in the Communities
Department of Health, Philippines
Operationalizing Health Services
CURRENT LOCAL
HEALTH SYSTEM
LGU
Technical Assistance, IRA allocation, Health Financing of identified
Grants, Subsidies and Workers and Health Services
Standards Setting Infrastructure
Provision of Primary Health Care Services
Primary Care and Treatment focused and
Community Based Services Hospital Based Services
CURRENT LOCAL
Pathway
HEALTH SYSTEM
Patients go to whichever health care facility they prefer to,
usually leading to a mismatch of their health problems and
available health services.
Seldom are patients referred to appropriate health care facilities
in a clear clinical pathway (from BHS to apex hospital)
System
CURRENT LOCAL
HEALTH SYSTEM No shared
accountability of Inequitable
the patient. distribution of
Responsibility of one resources
health facility ends at the
Primary Care/
time of referral and
endorsement to another. Community Level
Services are not funded
enough.
Arbitrary
decisions and Prioritization of
varying Health Programs
guidelines on differ per
patient municipality and
navigation per per health facility.
health facility.
What will UHC be for you?
UHC ensures that EVERYONE
will be receiving OPTIMAL HEALTH SERVICES.
Every Filipino family is matched to a primary care team, who ensures that
they get the appropriate services they need in the appropriate facility.
Department of Health, Philippines
What will UHC be for you?
UHC ensures that NO PATIENT
WILL BE LEFT ALONE.
Creation of health networks that will navigate the patients throughout the
process of their Health Care Needs. From BHS to Higher Health Facilities back to
the BHS.
Department of Health, Philippines
What will UHC be for you?
UHC ensures that PRIMARY CARE / COMMUNITY HEALTH
will be STRENGTHENED.
Primary Care Services and Community Health will be strengthened. Prevention is
always better than Cure.
Department of Health, Philippines
What will UHC be for you?
LGUs will be provided with additional funding for Health Services.
Health Services in the LGU will be funded through a pooled fund. Health Workers will
be incentivized and compensated properly (Additional health workers may be
employed). Pooled fund will remain and be reflected as LGU Income.
Department of Health, Philippines
What will UHC be for you?
LOCAL CHIEF EXECUTIVES as CHAMPIONS OF HEALTH
LGUs will be empowered to lead on Public Health in their areas. Health Governance is key to
a Healthy Community. (RA 11223 did not explicitly repeal LGC)
Department of Health, Philippines
As an LGU, what can you do?
FOR FAMILIES/ IN YOUR BARANGAYS... IN YOUR
HOUSEHOLDS UNDER YOUR ● Ensure good HCW ratio ● Improve facility GOVERNMENT
PURVIEW... in all BHS equipment and ● MakeOFFICE...
sure that a Local Health
● Create healthy settings and infrastructure Board is functional
healthy environment in your ● Assure that your HCWs
communities actively coordinate and ● Ensure no stock-out of ● Capacitate health through
navigate care for medicines and supplies sound budgeting
● Make sure that all families patients seeking
are profiled and with up-to- consultation ● Bank on good data for ● Create Ordinances and
date civil registration sound decision-making in Resolutions supporting UHC
● Make sure all essential health and other health programs
● Be responsible in health services
disseminating the message prescribed by UHC are ● Make sure doctor visits ● Engage DOH, PhilHealth, and
of UHC available 24/7 every barangay at least 2x Development Partners for
a year programs and initiatives
Department of Health, Philippines
Remember that in UHC,
You will become Good Health = There is a need for better
Health Innovators Good Politics Resource Management
=
You are the first to Better management of
implement UHC Good Health Policies and resources may pave way for
nationwide. Management translates to more revenues.
Healthier Constituents.
Department of Health, Philippines
Remember that in UHC,
Hard Work There is value in Multi- Services must
is essential Sectoral Cooperation focus on the Patient
The UHC reform is a paradigm We cannot work in “Silos” LGUs should push for accessible,
shift. It will entail a lot of hard anymore. All stakeholders need comprehensive, continuous,
work. to contribute for UHC’s success. and coordinated care for every
individual.
Department of Health, Philippines
