UHC MODULE 7

Method of paying health care providers based on the number of people within their catchment area:

a. Capitation

The following reflects the major steps in the management of the Special Health Fund:

a. creation; planning and budgeting; disbursement and utilization; monitoring, transparency and accountability

The general term for the way PhilHealth will pay health care providers for services delivered to the covered population:

a. Provider-Payment Mechanism

The three main functions of an effective health financing system:

a. revenue generation, pooling, strategic purchasing

The management of the Special Health Fund is being monitored through the Local Health Systems Maturity Levels under the
following P/CWHS characteristic:

a. Financial Management

The following serve as the bases of the Provincial and City Health Board for the planning and budgeting of the Special Health
Fund:

a. Only A and B are correct.

The provision of regular meal, bed in shared room, fan ventilation, and shared toilet and bath during hospital confinement:

a. Basic accommodation

A patient who opt for non-basic accommodation is charged a form of co-payment for hospital services, professional fees, and
fringe or additional amenities. The following are considered as examples of fringe or additional amenities:

a. Only A and C are correct.

The following member categories are covered by the current No Balance Billing (NBB) policy, EXCEPT:

a. Individual paying member

All health care providers shall comply with the prescribed allocation of basic and non-basic accommodation within their facilities.
Which of the following bed ratios stated in the Universal Health Care Act is correct?

a. All private hospitals shall allocate 10% of their approved bed capacity to basic accommodation.

The agency responsible to develop monitoring tools to track the implementation of the No Co-Payment Policy:

a. Philippine Health Insurance Corporation

The following are the possible sources of funds for the Special Health Fund:

a. All of the above are correct.

The least effective method of paying health care providers in terms of driving efficiency, as this motivates providers to over-
provide services:

a. Fee-for-service

The following are the allowable expenses for the Special Health Fund, EXCEPT:

a. Remuneration of all health workers

Which of the following statements is incorrect?

a. The Joint Memorandum Circular on Special Health Fund provided the minimum fund level that will be allocated for
equity purposes.

This entity has the full responsibility in the management of the Special Health Fund:
 a. Provincial/City Health Board

The Special Health Fund shall be maintained at the following LGU levels that committed to integrate, EXCEPT:

a. Component Cities

The appropriation of the budget from the following LGU fund requires an ordinance passed by the Sanggunian:

a. General Fund

Method of paying health care providers based on bundling together sets of health services and resources into single payment
amounts:

a. Case-based payments

Method of paying health care providers based on classifying cases into a group with the same characteristics in terms of
diagnoses, procedures, and expected resource use:

a. Diagnosis-related groups

PhilHealth’s current provider-payment mechanism:

a. All Case Rates Method

The number assigned to each DRG that reflects resource intensity based on collected cost data:

a. Relative Weight (RW)

The implementation of the Global Budget by PhilHealth will be based on the following:

a. Only A and B are correct

The provision of minimum standards of care for patients including fringe or additional amenities at the option of the patient
during hospital confinement:

a. Non-basic accommodation

Method of paying health care providers based on a lump sum amount paid prior to an agreed-upon time period:

a. Global Budget

The flat fee or predetermined rate paid at the point-of-service:

a. Co-payment

The following document is the primary basis for the transfer of funds from DOH to the LGU:

a. Terms of Partnership

The direct payment of a portion of health care costs by an insured person when receiving health services:

a. Cost-sharing

The No Co-Payment policy will remain in effect in the provision of the following PhilHealth benefit packages during the transition
period of shifting from No Balance Billing policy to No Co-payment policy:

a. Z Benefits and COVID-19 benefits

The following correctly differentiates No Balance Billing policy from No Co-Payment policy:

a. The No Balance Billing policy is based on membership categories whereas the No Co-Payment policy is based on the
hospital accommodation type.

Method of paying health care providers based on bundling together sets of health services and resources into single payment amounts:

A. Case-based payments