UHC Orientation - BHW

Universal Health Care Act
Relevant Provisions of RA 11223

Ok ka lang?!
v
Ano nangyari?!
ANG SAKIT!!!
‘DI KO NA KAYA.
Nandito na tayo
sa hospital.
Gagamutin ka na.
Konting tiis na
lang.
ANG SAKIT!!!
The patient is
suffering from
ectopic pregnancy.
She needs to
undergo
laparoscopy.
OK ka Get some quality
na? rest. You can go
home now.
Upon discharge, patient was presented with the following bill:
Central sterile supplies 1,154.00 Oxygen 448.00 Professional Fee Charges
Emergency Room 850.00 Delivery Room 350.00 Doctor Charges PhilHealt

ANG SAKIT h
Emergency Room
Procedure Fee
SA BULSA!!!
650.00 Returned Medicines (2,405.10
) Doctor 1 (ER) 29,556.0 (4,566.00
0 )
Emergency Room Supplies 1,384.55 Room and Board 4,200.00
Doctor 2 (Ob- 62,450.0 (9,072.00
Laboratory 15,885.00 Ultrasound 3,215.00 Gyne) 0 )
Operating Apparatus 10,215.00 General Patient’s Discount (2,485.00 Doctor 3 2,403.00 (0.00)
) (Pathologist)
Operating Room Fee 9,000.00
PhilHealth (12,000.0 Doctor 4 5,100.00 (1,512.00
Operating Room 1,862.00 0) (Anesthesiologist )
Miscellaneous
Net Hospital Bill 50,338.6
Total Bill: P209,150.62
)
Operating Room Supplies 18,105.00 2 Net Amount to Pay 158,812.

62
Talk of the Town
Perspective of Citizens/Patients/Clients
Umalis nanaman Paano ko malalaman Confine nalang daw

si doc, kailan kung legit ung clinic? para maka kuha ng
kaya ulit safe yung gamot? PhilHealth pati gamot
magkakaroon?
Hindi ko nga Nangutang ako para Wala na daw kama sa

naintindihan ano ang mabayaran ung charity, pinapalipat
pinabayaran eh paospital kami sa pay/private
Talk of the Town
Perspective of the Local Implementers
Magpapatayo
kung pati- Ang hirap mag plano
munisipyo ng Di namin magamit nang walang datos Priority ni XX ang
hospital kahit ung PhilHealth lalo na ung mga palakihin ang
hindi kailangan namin… private ayaw ospital eh
magbigay
Anong petsa na? Wala na daw kama

Hindi kami natutulungan wala pa din ang sa charity, Sino ba talaga ang
kasi hindi kakampi ni PhilHealth pinapalipat kami miyembro?
Mayor si Gov eh
sa pay/private
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
○ ensure health literacy, healthy living, and protection from hazards and risks
○ provide comprehensive health services without causing financial hardship
● 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

Universal Health Care means….
✔ healthy living, schooling & ✔ primary care provider ✔ health spending is
working environments team for every family predictable, not “lahat libre”

Universal Health Care means….
✔ healthy living, schooling & ✔ primary care provider ✔ health spending is
working environments team for every family predictable, not “lahat libre”

A “Systemic” Approach to UHC
Financing ✭ Service Delivery ✭ Regulation ✭ Governance
WHY SYSTEMIC APPROACH
We may give every Filipino a PhilHealth card, but it is useless if there is

no facility they can present that card to for treatment
We may erect hospitals with gleaming glass and steel, but if there are no
doctors and other health professionals who will staff and run them, then
what we have built are white elephants.
"
17

WHY SYSTEMIC APPROACH
We have many modern curative facilities, but when the sick are
continuously dumped on them because we have neglected the promotive
and the preventative aspects of medicine, then we have failed to address
the roots.
We may have a cadre of health professionals scattered nationwide, but if

drugs are expensive, then the road to wellness is blocked.
We may have a built a network of hospitals but if they are not constantly
infused with funds, then they cannot function fully due to budgetary
anemia.
18

Financing (1)
Eliminating redundancies: Simplifying membership

• population-based – DOH, LGU into two types: Direct &
• individual-based - PHIC Indirect Contributory
Pooling funds to PhilHealth Improving current

for all individual-based health provider payment
services (e.g. Sin Tax, mechanisms (see next
PAGCOR, PCSO) slide)
19

Service Delivery (1)
Contracting by network and Improving pool, presence,

designating primary care perspective of HCWs (see
providers* as navigator next slides)
Consolidating public system Securing resources and

into province-wide and city- retaining income for health
wide health systems through a special health
fund
21

Regulation (1)
Benefit complementation
Transparent pricing of between PhilHealth and Private
health goods and services Health Insurance (PHIs) and
Health Maintenance
Organizations (HMOs)
Basic and non-basic

Licensing for stand-alone health
accommodation* bed ratio facilities, ambulatory and PCP
• 90:10 for government
• 70:30 for government Registry of health care
specialty providers
• 10:90 for private hospitals
28

Regulation (2)
Basic Accommodation – refers to the provision of regular meal, bed

in shared room, fan ventilation, and shared toilet and bath
Amenities – refers to features of the health services provide comfort

or convenience, such as private accommodation, air conditioning,
telephone, and choice of meals, among others

Governance (1)
Allocating funding and Mandatory use of IT systems

scaling up Health and submission of health and
Promotion initiatives (see financial data by healthcare
next slide) providers and suppliers
Mandating Health Impact Promoting fairness and

Assessment for all transparency in benefits
programs, policies, and expansion through Health
projects Technology Assessment
30

UHC, in a nutshell
Begin with these ENDS in mind
Universal Health Care is about…
Health Literacy &
Healthy Settings
Financial Coverage
• Zero co-payment
• Fixed, predictable co-
payment
Pool of Funds
Service Coverage
• immediate eligibility and access
Population Coverage - • comprehensive outpatient benefit
automatic inclusion of • provision of primary care provider
every Filipino citizen into
the NHIP

It means everyone wins!
Filipinos/Patients are health literate, Payers (private insurers, governments, or self-pay
practice healthy lifestyle, live in low-risk individuals) able to shape provider behavior
environments, receive effective care towards quality and efficiency
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

"We may give every Filipino a PhilHealth card, but it is useless if there is no facility they can present
that card to for treatment," said Senator Recto.
"We may erect hospitals with gleaming glass and steel, but if there are no doctors and other health
professionals who will staff and run them, then what we have built are white elephants.
"We have many modern curative facilities, but when the sick are continuously dumped on them
because we have neglected the promotive and the preventative aspects of medicine, then we have
failed to address the roots.
"We may have a cadre of health professionals scattered nationwide, but if drugs are expensive, then
the road to wellness is blocked.
"We may have a built a network of hospitals but if they are not constantly infused with funds, then
they cannot function fully due to budgetary anaemia

Maraming salamat po!

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Universal Health Care Act

Relevant Provisions of RA 11223

Central sterile supplies 1,154.00 Oxygen 448.00 Professional Fee Charges

Emergency Room 850.00 Delivery Room 350.00 Doctor Charges PhilHealt

Operating Room Supplies 18,105.00 2 Net Amount to Pay 158,812.

Umalis nanaman Paano ko malalaman Confine nalang daw

Hindi ko nga Nangutang ako para Wala na daw kama sa

Anong petsa na? Wala na daw kama

Coordinated, not piecemeal Know our role to

Department of Health - Philippines

Department of Health - Philippines

Department of Health - Philippines

Department of Health - Philippines

We may give every Filipino a PhilHealth card, but it is useless if there is

Department of Health - Philippines

We may have a cadre of health professionals scattered nationwide, but if

Department of Health - Philippines

Eliminating redundancies: Simplifying membership

Pooling funds to PhilHealth Improving current

Department of Health - Philippines

Contracting by network and Improving pool, presence,

Consolidating public system Securing resources and

Department of Health - Philippines

Basic and non-basic

Department of Health - Philippines

Basic Accommodation – refers to the provision of regular meal, bed

Amenities – refers to features of the health services provide comfort

Department of Health - Philippines

Allocating funding and Mandatory use of IT systems

Mandating Health Impact Promoting fairness and

Department of Health - Philippines

Department of Health - Philippines

Department of Health - Philippines

Department of Health - Philippines

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