UNIVERSAL HEALTH

CARE LAW
 Primary health care is the most efficient and cost-effective
way to achieve universal health coverage around the world.
 To meet the health workforce requirements of the Sustainable
Development Goals and universal health coverage targets, over
18 million additional health workers are needed by 2030. Gaps in
the supply of and demand for health workers are concentrated in
low- and lower-middle-income countries. The growing demand for
health workers is projected to add an estimated 40 million health
sector jobs to the global economy by 2030. Investments are
needed from both public and private sectors in health worker
education, as well as in the creation and filling of funded positions
in the health sector and the health economy.
 UHC emphasizes not only what services are covered, but
also how they are funded, managed, and delivered. A
fundamental shift in service delivery is needed such that services
are integrated and focused on the needs of people and
communities. This includes reorienting health services to ensure
that care is provided in the most appropriate setting, with the right
balance between out- and in-patient care and strengthening the
coordination of care. Health services, including traditional and
complementary medicine services, organized around the
comprehensive needs and expectations of people and
communities will help empower them to take a more active role in
their health and health system.
 Can UHC be measured?

 Yes. Monitoring progress towards UHC should focus on 2 things:

The proportion of a population that can access essential quality
health services.
The proportion of the population that spends a large amount of
household income on health.
 Together with the World Bank, WHO has developed a framework
to track the progress of UHC by monitoring both categories, taking
into account both the overall level and the extent to which UHC is
equitable, offering service coverage and financial protection to all
people within a population, such as the poor or those living in remote
rural areas.
 WHO uses 16 essential health services in 4
categories as indicators of the level and equity of
coverage in countries:
Reproductive, maternal, newborn and child health:
 family planning
 antenatal and delivery care
 full child immunization
 health-seeking behaviour for pneumonia.
Infectious diseases:
 tuberculosis treatment
 HIV antiretroviral treatment
 Hepatitis treatment
 use of insecticide-treated bed nets for malaria
prevention
 adequate sanitation.
Noncommunicable diseases:
 prevention and treatment of raised blood pressure
 prevention and treatment of raised blood glucose
 cervical cancer screening
 tobacco (non-)smoking.
Service capacity and access:
 basic hospital access
 health worker density
 access to essential medicines
 health security: compliance with the International Health
Regulations.
 Each country is unique, and each country may focus on
different areas, or develop their own ways of measuring progress
towards UHC. But there is also value in a global approach that
uses standardized measures that are internationally recognized so
that they are comparable across borders and over time.
WHO role on UHC

 UHC is firmly based on the 1948 WHO Constitution, which

declares health a fundamental human right and commits to
ensuring the highest attainable level of health for all.
 WHO is supporting countries to develop their health
systems to move towards and sustain UHC, and to monitor
progress. But WHO is not alone: WHO works with many
different partners in different situations and for different
purposes to advance UHC around the world.
 On 25–26 October 2018, WHO in partnership with UNICEF and the
Ministry of Health of Kazakhstan hosted the Global Conference on Primary
Health Care, 40 years after the adoption of the historic Declaration of Alma-
Ata. Ministers, health workers, academics, partners and civil society came
together to recommit to primary health care as the cornerstone of UHC in
the bold new Declaration of Astana. The Declaration aims to renew political
commitment to primary health care from governments, non-governmental
organizations, professional organizations, academia and global health and
development organizations.

 All countries can do more to improve health outcomes and tackle

poverty, by increasing coverage of health services, and by reducing the
impoverishment associated with payment for health services.
Overview
 The world has committed to making health for all a reality. Primary health care
is one of the best tools we have for achieving that goal. Through the Declaration of
Astana, countries have reaffirmed the importance of PHC. We risk, however, that
global consensus becoming nothing more than a pipe dream unless countries can
turn the four commitments into action on the ground.
 In recent decades, PHC has been neglected in many countries in favor of a
disease-specific approach. This is often due to a combination of lack of political will,
under investment, and common misperceptions of the role and benefits of
PHC. Political will has advanced greatly with the adoption of the Declaration of
Astana.
 There are a number of economic arguments in favor of increasing investment in
PHC. It has been proven that health systems with a PHC-based foundation result in
improved clinical outcomes, increased efficiency, better quality of care and
enhanced patient satisfaction.

 All stakeholders – from government leaders to physicians to members of the

public – need to be made aware of the role and benefits of PHC. Some common
misperceptions include the notion that PHC only provides “basic” care, when, in
fact, PHC provides essential care that can cover the majority of a person’s health
needs throughout their lives. Another misperception is that PHC is about maternal
and child health – PHC is about health at all ages. PHC involves prevention, health
promotion, treatment, rehabilitation, and palliation.
 Another misperception is that PHC is “cheap” health care for
the poor. Because PHC is based in the community, it is frequently
the only health care available to poor or marginalized
communities, who may not have access to a hospital. Because
PHC focuses on the person rather than the disease, it is an
approach that moves away from overspecialization. In PHC, the
goal is to work through multidisciplinary teams with strong referral
systems to secondary and tertiary care when needed.

 But PHC also goes beyond providing health care services to

individuals. It is a whole-of-society approach that seeks to address
the broader determinants of health, such as community-level
disease-prevention efforts, and to empower individuals, families
and communities to get involved in their own health.

 In 2018, world leaders committed to advancing PHC. However,

moving from political commitment to reality will require efforts
on the part of all stakeholders – governments, health care
providers, civil society, and the public.
What Filipinos can expect from
the Universal Health Care Law?

 MANILA, Philippines – Filipinos will begin benefiting from the

Universal Health Care (UHC) Act this year, with every citizen entitled
to health coverage that will lower out-of- pocket health expenses.
 The passage of the law was considered a landmark for the Duterte
administration as lawmakers who championed the bill gathered in
Malacañang for a special ceremony last February 20. It was there that
President Rodrigo Duterte affixed his signature on the long-awaited
law.
 The passage of Republic Act No 11223 was no easy feat. It was
hailed as path-breaking as it set the direction for the reform of the
health care sector in the Philippines.
 The World Health Organization earlier urged the Philippine
government to make a “real investment” in health care, as it would
save lives.
 But ensuring universal health care for all Filipinos does
not come cheap.
 Health Secretary Francisco Duque III said some P254.8
billion has been allotted for the first year of implementation
of the law. He earlier said some P257 billion was needed.
 Now, the Department of Health (DOH), Philippine Health
Insurance Corporation (PhilHealth), along with experts and
concerned agencies are crafting the Implementing Rules and
Regulations (IRR). They will have 180 days to complete the
IRR, which will include details on how the law will be
executed.

 In the meantime, though, Filipinos can already expect to
avail of some of the law’s benefits. Full effects of the law will
be gradually felt over the years as the DOH and PhilHealth
start transitioning to the universal health care system.
1. ALL Filipinos are covered

 Every single Filipino citizen is automatically enrolled into

the newly-created National Health Insurance Program
(NHIP). The program classified membership into two types:

 Direct contributors – those who pay PhilHealth

premiums, are employed and bound by an "employer-
employee relationship," self-earning, professional
practitioners, and migrant workers. Members’ qualified
dependents and lifetime members are also included.

 Indirect contributors – those not considered as direct

contributors, along with their qualified dependents,
whose health premiums are subsidized by the
government.
1. ALL Filipinos are covered

 All Filipinos will be granted “immediate eligibility”

and access to the full spectrum of health care
which includes preventive, promotive, curative,
rehabilitative, and palliative care. This can be
expected for medical, dental, mental, and
emergency health services.

 Filipinos will also be enrolled with a primary

health care provider of their choice. The primary
care provider is the health worker they can go
and seek treatment from for health concerns.
They will also serve as the person in charge of
referring and coordinating with other health
centers if patients need further treatment.

 Citizens will not need to present any PhilHealth

ID to avail of these benefits. Meanwhile, poor
Filipinos or those who are located in
geographically isolated areas will also be given
priority when ensuring access to health services.
2. It is not completely free

 Contrary to what some people may think, UHC does not

mean every single health expense will be made free.

 The law outlines that basic services accommodations will

be covered by PhilHealth.

 As a patient, that means that if you’re admitted in a

hospital you can expect regular meals, a bed in a
shared room with fan ventilation, and a shared toilet and
bath to be covered.

 All are also entitled to an “essential health benefit

package,” which includes primary care, medicines,
diagnostic, and laboratory tests. It also includes
preventive, curative, and rehabilitative services.
2. It is not completely free

It will no longer be free when one wants to stay in a hospital

room offering private accommodation, air conditioning,
telephone, television, and meal choices, among others.

 Meanwhile, public and private hospitals are expected to

allocate a certain portion of their beds as basic
accommodations in the following amounts:

 Government hospitals – at least 90% of beds

 Specialty hospitals – at least 70% of beds
 Private hospitals – at least 10% of beds

 As long as a patient avails of these basic

accommodations, it will be covered by PhilHealth
whether in a public or private hospital.
2. It is not completely free
The law also states that if patients need to
pay for extra expenses, their “co-payment” –
or what is paid on top of basic services –
should be regulated by the DOH in public
hospitals. This means that you should know
what to expect in terms of bills, as opposed
to being shocked after treatment. Aside from
this, current case rates or packages
PhilHealth has crafted for certain diseases
will remain. But together with the DOH,
PhilHealth is expected to work towards
including more needs a person may have
for a disease in its case rates.
The two agencies are also expected to craft
and implement outpatient benefit services to
be covered by the National Health
Insurance Programs within 2 years after the
law takes effect.
3. PhilHealth will become the “national
purchaser” of health goods and
services
This means that PhilHealth will be in charge of
paying health care providers like hospitals and
clinics for services given to Filipinos. This is
already a job PhilHealth carries out but the
universal health care law wants to pool more
funds so it can cover all Filipinos and eventually,
more services.
Allocating more funds to PhilHealth will also
strengthen its negotiating power with health care
providers, which will foreseeably improve the
quality of services and lower health costs.
3. PhilHealth will become the “national
purchaser” of health goods and
services
Funds for PhilHealth will be sourced from the following:
 Philippine Amusement and Gaming Corporation – 50%
of national government’s share
 Philippine Charity Sweepstakes Office (PCSO) – 40%
of its charity fund, net of document stamp tax
payments, and mandatory PCSO contributions
 Premium contributions of direct contributory members
 PhilHealth annual budget

With multiple fund sources for PhilHealth, Filipinos will no

longer need to troop to various government offices to
secure funds to pay for health expenses. It will also make
them less dependent on politicians to help pay for health
services.
3. PhilHealth will become the “national
purchaser” of health goods and
services
By giving PhilHealth more funds, a goal of the UHC is to
make PhilHealth the national purchaser of medicines. This
can lower the cost of medicines as these will be bought in
bulk.

Another goals is to have quality of health services

improve as PhilHealth can set as a requirement for
payment and contracting, standards for health care
providers.
4. DOH will still be in charge of
“population-based” health services

While PhilHealth, along with other private

health insurance companies, is expected to
cover services for individuals, the DOH is
still in charge of delivering health services
that cover entire populations.
Think of these as programs for disease
surveillance, health promotion campaigns,
and mass immunization campaigns.
The DOH will do this by contracting public
health care providers in cities and
provinces.
5. Health systems will become city-
wide and province-wide

Provinces and highly urbanized cities will

now be in charge of overseeing health
services in areas as opposed to the current
set-up where municipalities are tasked with
managing their own health centers.

•The DOH will need to work with the

Department of the Interior and Local
Government (DILG) to have province- and
city-wide health systems or networks in
about two years after the law takes affect.
5. Health systems will become city-
wide and province-wide
• For this, one can imagine as an example,
Rizal overseeing its province-wide health
care network of clinics and hospitals
compared to each municipality in Rizal
taking care of its own health center alone.

• Similarly, highly urbanized cities like Cebu

or Makati will oversee their own health care
network compared to single barangays
being in charge of a health center.
Having access to health networks
province-wide can address the problem of
inadequate access to health services due
to lack of funds in barangays or
municipalities.

• Provincial and city health boards will be in

charge of pooling and managing a special
health fund to finance and improve health
services
6. Return service in the public health
sector

 Graduates of health and health-related courses

who received government-funded scholarships will be
required to work in the public health sector for at least
3 full years. This will address the need for health
workers across the country.
 They will be paid by and under the supervision of
the DOH. Those who serve for an extra two years will
also be given incentives, which will be determined by
the DOH.
 Meanwhile, graduates of health courses in state
universities and colleges and private schools are
encouraged to work in the public sector.
7. A “Health Technology and Assessment
Council” (HTAC) will be created
 The Health Technology Assessment Council
(HTAC) is an independent advisory body created
under the Republic Act 11223, otherwise known as
the Universal Health Care Act, with the overall role of
providing guidance to the Department of Health
(DOH) and the Philippine Health Insurance
Corporation (PhilHealth) on the coverage of health
interventions and technologies to be funded by the
government. The mandate of the Council is to
undertake technology appraisals by determining
their clinical and economic values in the Philippine
healthcare system, with the aim to improve overall
health outcomes and ensure fairness, equity, and
sustainability of coverage for all Filipino citizens.
Ethical, legal, social and health system implications
are also considered in the assessments.
7. A “Health Technology and Assessment
Council” (HTAC) will be created

 The HTAC will be responsible for assessing

the safety and effectiveness of health
technology, devices, medicines, vaccines,
health procedures, and other health-related
advances developed to solve health problems.
 Reviewing the social, economic, and
ethical issues when using these technologies
or programs is also required.
 The HTAC will be attached to the DOH for
the first 5 years after the law is implemented.
After this, it will become an independent body
attached to the Department of Science and
Technology.
8. Health information will be collected

 Both public and private hospitals and

health insurers will be required to
maintain a health information system
that will contain electronic health
records, prescription logs, and “human
resource information.”

 This system will be developed and

Funded by DOH and PhilHealth. It will
also be subject to patient confidentiality
rules and data privacy laws