Universal Health Care
RA 11223: Universal Health Care Act
DECLARATION OF PRINCIPLES
Integrated and Everyone is actively
People at the Center
Comprehensive Approach participating
Ensure health literacy, healthy Whole-of-system Whole-of- People-oriented approach
living, and protection from government, Whole-of-society
centered on people’s needs and
approach in the development of
hazards and risks. well-being
health policies
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.
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
RA 11223: Universal Health Care Act
GENERAL OBJECTIVES
To progressively roll-out 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
What will UHC be for us?
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 us?
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 us?
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 us?
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
Universal Health Care
does not mean...
“A Cure All Reform”: Prescribed “Lahat Libre:”
reforms need to have careful execution Basic health services will be FREE,
to ensure success. but for fees beyond the basics, every
Filipino family’s health spending will be
predictable.
01 Scope of Universal Health Care
Philippines
UHC Reforms for Immediate Implementation to the Whole Country
UIS
Simplifying Pooling Funds National Regulating
Eliminating PhilHealth to PhilHealth HRH Coverage Co- Transparent
Redundancies Membership Master Plan payment Pricing
SHF
Integration-specific reforms
Technical Integration
Licensing Health Health
Managerial Integration
Setting and Health Impact Data Technology Financial Integration
Standards Registries Promotion Assessment Management Assessment
Department of Health, Philippines
1. Any Province / HUC / ICC can integrate.
Any LGU with their component LGUs can integrate their local
health systems. There is no need to seek approval nor
KEY permission from DOH.
MESSAGES
2. Availability of funds and matching of assistance to facilitate
province-wide/city-wide integration are dependent on the
UNIVERSAL budget preparation cycle at the National Government.
For DOH to propose budget to assist LGUs that wish to
HEALTH CARE integrate, they have to signify their intent. The DOH’s ability to
INTEGRATION commit will depend on the budget deliberation timelines and
SITES the results of their local strategic and investment planning.
Department of Health, Philippines
MODULE
X WHAT CAN LOCAL
HEALTH SYSTEMS DO?
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 ● OFFICE...
Make sure that a Local Health
● Create healthy settings and infrastructure Board is functional
healthy environment in ● Assure that your HCWs
your 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 Development Partners for
2x a year programs and initiatives
Department of Health, Philippines
As an LGU, what can you do?
IN YOUR HEALTH UNITS... IN DISTRICT HOSPITALS
IN APEX HOSPITALS
● Encourage your physicians to
● Improve facility WITHIN YOUR
actively coordinate and WITHIN YOUR
navigate care for patients
equipment and NETWORK...
seeking consultation
infrastructure ● Make sure outpatient and NETWORK...
community services are ● Strengthen partnership
● Ensure no stock-out of
● Make sure all essential health and commitment thru
medicines and supplies available in case these
services prescribed by UHC creation of MOAs
are available 24/7. If not services cannot be availed
● Bank on good data for
available, make sure that sound decision-making in
by patients in your health
transport vehicles are health units
available in care there is a
need to refer ● Make sure a two-way ● Ascertain that the referral
referral system is in place system is in place and is
● Ascertain that the facility/ies
is are PhilHealth accredited ● Ascertain that your unit
smoothly functioning
has a MESU
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.
Department of Health, Philippines
Maraming salamat po!
Contracting by HIDDEN
Network Pathway of Patient Enlisted in a Network SLIDE
HOSPITAL
HOSPITAL
Charge toCharge
network
to 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
