Universal Health Care

OUTLINE
Universal Health Care
1. What is UHC for Juan and Juana?

2. Key components of the UHC Act

3. What is a UHC Integration Site

4. Expectations for Strategic Planning

Department of Health, Philippines

What is UHC for
Juan and Juana?

3
Department of Health, Philippines
Department of Health, Philippines
 BARANGAY
RURAL HEALTH HEALTH
UNIT STATION

DIAGNOSTICS SPECIALIST CLINICS

HOSPITAL
LABORATORIES

PHARMACIES APEX HOSPITAL

Department of Health, Philippines

Department of Health, Philippines
Department of Health, Philippines
Department of Health, Philippines
 DIAGNOSIS:

PNEUMONIA

Department of Health, Philippines

Department of Health, Philippines
Department of Health, Philippines
 LAB

Department of Health, Philippines

 50% 50%
patient PCP
SPECIALIST

Department of Health, Philippines

Department of Health, Philippines
 Key Components of the
Universal Health Care Act

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 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

 RA 11223: Universal Health Care Act
GENERAL OBJECTIVES

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 Everyone is actively

People at the Center
Comprehensive Approach participating

Ensure health literacy, healthy living, and
protection from hazards and risks.
Whole-of-system Whole-of-government, People-oriented approach centered on
Whole-of-society people’s needs and well-being
approach in the development of health
policies

Department of Health, Philippines

 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

 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...

“A Cure All Reform”: Prescribed “Lahat Libre:”

reforms need to have careful Basic health services will be FREE,
execution to ensure success. but for fees beyond the basics, every
Filipino family’s health spending will be
predictable.

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

 What is a
UHC Integration Site?

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 Scope of the UHC Integration Sites (UIS)

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

 UHC Integration Sites

UHC Integration Sites (UIS) are provinces

and/or cities that will be supported and
contracted by DOH & PhilHealth to
demonstrate various approaches and mechanisms
to achieve:
TECHNICAL INTEGRATION
MANAGERIAL INTEGRATION by 2022
FINANCIAL INTEGRATION by 2025
as prescribed by the UHC Law.

Department of Health, Philippines

 UHC Integration Sites

The lessons and experience generated from

these sites will serve as basis for the
development of national policies on the
integration of local health systems to attain
Universal Health Coverage.

Department of Health, Philippines

 FOR GOVERNMENT
TECHNICAL INTEGRATION
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
FOR PATIENTS
Human
Effective access
Finances MANAGERIAL INTEGRATION
Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
FINANCIAL INTEGRATION Career productivity
 Integrating Local
Health Systems Dimensions of Integration
A. Technical Integration
Encompasses the clinical and public
health functions to deliver seamless,
coordinated, comprehensive primary
health care with intersectoral
participation
Department of Health, Philippines
B. Managerial Integration
Consolidated administration and
management of public resources at the
province-wide/city-wide level: Human
resources for health, health facilities and
equipment, health information system,
health technologies and medicines
C. Financial Integration
Consolidating all financial resources
within a province-wide/city-wide health
system in a Special Health Fund,
exclusively and strategically used for
health and health-related needs.
 FOR GOVERNMENT
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
FOR PATIENTS
Human
Effective access
Finances Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
 PATIENT 1. Patients receive zero co-pay or are subject to regulated
OUTCOMES co-pay ceilings where relevant
2. Patients have access to the health personnel and services
they need in a timely manner
3. Patients have access to the medicines and devices they
need in a timely manner
4. Patients trust the HCPN in their city or province
5. Patients benefit from comprehensive, responsive and
effective public health services to the entire province/city

Department of Health, Philippines

 FOR GOVERNMENT
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
FOR PATIENTS
Human
Effective access
Finances Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
Technical Integration
1. Population catchment enumerated and needs
estimated
2. All families matched to PCP teams and PCP acts
as coordinator and navigator
3. Care coordination operational (dual referral system
- from primary to apex, then back to primary)

4. Public health functions fulfilled (disaster risk

reduction and management for health,
epidemiologic surveillance)

Department of Health, Philippines

Managerial Integration
5. Unified governance and management systems
6. Sufficient, competent clinical and management staff
aligned to the network vision-mission
7. Network-wide results-based performance monitoring
and evaluation implemented
8. User-friendly health information systems informing
performance of each unit, and the network as a whole

Department of Health, Philippines

Financial Integration

9. Network-wide pooling and accounting of funds

10. Network-wide investment and resource
allocation

Department of Health, Philippines

 FOR THE NATIONAL
GOVERNMENT
EXISTING Health system outcomes
Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
Human FOR PATIENTS
Finances Effective access
Facilities Trust
Equipment Quality care
Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
 Capacity Building & Health Systems
Scholarships for LCEs Health Worker
Development
Development

Information Systems Procurement Process

and EMR and Systems

DOH Intervention Packages

Health Emergency & Health Education and
Management Services Promotion

Department of Health, Philippines

 PhilHealth Intervention Packages
New financial mechanism that will support the local health systems in
delivering accessible quality and affordable health services.

Particularly for PhilHealth:

● Demonstrate network contracting
● Introduce global budget
● Improve primary care benefit
package (higher capitation, disease-
agnostic)

Department of Health, Philippines

 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

 If LGUs that commit to
integrate request technical and financial
assistance
1. LCEs must signify commitment to managerial
integration by 2022 and financial integration by 2025
2. Agree to and fulfill the terms of partnership that will
enable the optimal performance of the integrated
local health system through the provision of needs-
based support by the National Government

Department of Health, Philippines

 The Aspiration

Assurance through Coordination

Holistic and Comprehensive Unavailable but needed services of
Services at Point of Care the client are ensured by the
All services eligible provider
to a client are given. through other providers

Department of Health, Philippines

 Committing to be a UIS means

SHF

Families are linked to Health services are Facilities in a network The Special Health Eligible networks are
a primary care streamlined are linked to an apex Fund pools resources financed thru a Global
provider hospital for health Budget

Department of Health, Philippines

INTEGRATING LOCAL
HEALTH SYSTEMS Province- and City-wide Health Systems
• Provincial/City Health Board shall:
• oversee integration of health services
• manage the special health fund
• exercise administrative and technical supervision over
health facilities and HRH within their jurisdiction
• Municipalities and cities shall be represented in the
Board

Department of Health, Philippines

INTEGRATING LOCAL
HEALTH SYSTEMS Province- and City-wide Health Systems
• National Government to provide technical and financial
support to LGUs that commit to province-wide integration in
the first 6 years
■ Managerial integration of province-wide and
city-wide systems within the first 3 years;
■ Financial integration within the next 3 years
• Upon positive recommendation by an independent study and
by the Secretary of Health, all local health systems shall be
integrated through the issuance of an E.O. by the President

Department of Health, Philippines

MODULE

X WHAT CAN LOCAL

HEALTH SYSTEMS DO?

Department of Health, Philippines


FOR FAMILIES/
HOUSEHOLDS UNDER
YOUR PURVIEW...
● Create healthy settings and
healthy environment in
your communities
● Make sure that all families
are profiled and with up-to-
date civil registration
● Be responsible in
disseminating the message
of UHC
Department of Health, Philippines
As an LGU, what can you do?
IN YOUR BARANGAYS... IN YOUR GOVERNMENT
OFFICE...
● Ensure good HCW ratio ● Improve facility
in all BHS equipment and ● Make sure that a Local Health
infrastructure Board is functional
● Assure that your HCWs
actively coordinate and ● Ensure no stock-out of ● Capacitate health through
navigate care for medicines and supplies sound budgeting
patients seeking
consultation ● Bank on good data for ● Create Ordinances and
sound decision-making in Resolutions supporting UHC
● Make sure all essential health and other health programs
health services
prescribed by UHC are ● Make sure doctor visits ● Engage DOH, PhilHealth, and
available 24/7 every barangay at least Development Partners for
2x a year programs and initiatives

IN YOUR HEALTH UNITS...
● Encourage your physicians to
actively coordinate and
navigate care for patients
seeking consultation
● Make sure all essential health
services prescribed by UHC
are available 24/7. If not
available, make sure that
transport vehicles are
available in care there is a
need to refer
●
Ascertain that the facility/ies
is are PhilHealth accredited
Department of Health, Philippines
As an LGU, what can you do?
● Improve facility
equipment and
infrastructure
● Ensure no stock-out of
medicines and supplies
● Bank on good data for
sound decision-making in
health
● Make sure a two-way
referral system is in place
● Ascertain that your unit
has a MESU
IN DISTRICT HOSPITALS
WITHIN YOUR IN APEX HOSPITALS
NETWORK... WITHIN YOUR
NETWORK...
● Make sure outpatient and
community services are ● Strengthen partnership
and commitment thru
available in case these
creation of MOAs
services cannot be availed
by patients in your health
units
● Ascertain that the referral
system is in place and is
smoothly functioning
 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
implement UHC Good Health Policies and Better management of
nationwide. Management translates to resources may pave way for
Healthier Constituents. more revenues.

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

 Expecatations for
Strategic Planning of UIS

60
GUIDING PRINCIPLES
1. Health shall be a shared accountability among the State,
communities and individuals.
a. Taking ownership of health in the individual and community level
shall be made possible by investing in improving overall health
literacy.
b. Protection from financial risk shall be achieved thru a mechanism
to pool / share risks, such that those who can pay more are able
to support those who can pay less, that those who are well can
support those who are sick.
c. Basic health benefits shall be covered by the State while non-
basic or fringe benefits shall be shouldered by the individual.

Department of Health, Philippines

GUIDING PRINCIPLES
2. Equity and fairness shall guide the path towards
universality.
a. All Filipinos, regardless of socio-economic standing,
ethnicity, religious belief, political affiliation, source of
payment of premiums shall receive the same benefits
package under UHC.
b. Recognizing limited resources, universality shall be
progressively realized by prioritizing the needs of the
unserved, underserved, and marginalized through
evidence-based health technology assessment, and
fair and transparent priority setting.

Department of Health, Philippines

GUIDING PRINCIPLES
3. Primary health care shall be the ethos of the health system;
primary care providers shall be the bedrock of healthcare delivery
system.
a. Individual and community health and wellbeing does
NOT not depend solely on healthcare services. Multi-
sectoral action shall be fostered to address the broader
social determinants of health.
b. Investments shall be directed to shifting from a hospital-
centric, curative-focused fragmented system, towards a
people-centered, primary care-led integrated health
system.

Department of Health, Philippines

GUIDING PRINCIPLES
4. Healthcare delivery shall be patient-centric.

a. Patients shall be guaranteed access to, and

availability of, all services and commodities
deemed necessary and essential by the State.
b. Patients shall be provided necessary care
from any provider of choice.
c. In the event of any conflict of rules or
guidelines, the safety and need of the patient
shall prevail.

Department of Health, Philippines

GUIDING PRINCIPLES
5. Information shall guide decision-making at the institutional
and individual level.

a. With due respect to privacy, information on health

transactions shall be collected and processed.
Maximum disclosure of depersonalized data shall
be exercised by healthcare providers and
institutions.
b. Information and power asymmetry between
various stakeholders in health shall be minimized.

Department of Health, Philippines

GUIDING PRINCIPLES
6. There shall be equal pay for equal work; better pay for better
(more efficient, higher quality) work.

a. Licensed, accredited and contracted health service providers and suppliers

shall receive remuneration commensurate to the level of effort and quality of
service they provide, regardless of ownership or affiliation (agnostic).
b. The system shall incentivize health service providers and suppliers that add
value to the system and those which facilitate demonstrable improvements in
quality and efficiency, including embedding new technology, among others.
c. PhilHealth shall seek to cover the costs of all the services provided
(improved support value), taking into consideration all sources of financing.

Department of Health, Philippines

 Outputs of the Strategic Planning Process
Network Network Network
Vision Analysis Arrangements
Allocation of catchment areas to
potential HCPNs
Legal personality
Vision Stakeholder analysis
Management structure
Strategies Facility mapping
Decision making structure
Milestones and Timeline Service capability mapping
Facility network formation
HRH mapping
Strategic Planning Timeline and Patient flow processes
Processes Health status of population
HRH plan
Integrated investment plans
Monitoring and Evaluation

Department of Health, Philippines

 Contracting by
Network Pathway of Patient Enlisted in a Network

HOSPITALHOSPITAL
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
CONTRACTING
BY NETWORK Healthcare Provider Networks
• Philhealth to contract public, private or mixed health
care provider networks
• geographically-defined catchment area
• service quality
• co-payment/co-insurance
• data submission
• PhilHealth and DOH to incentivize health care providers
that form networks

Department of Health, Philippines

 Draft
Standards
Network Facility
Structure

APEX HOSPITAL

HEALTH CARE
PROVIDER
NETWORK (HCPN)
TRANSITION CARE
L1-L2 HOSPITAL FACILITIES

PRIMARY CARE
PROVIDER OUTPOSTS
NETWORK (PCPN) and
ANCILLARY
HEALTH
PROVIDERS
PRIMARY CARE (To complete
FAMILY FACILITY network service
70
(Comprehensive and Basic) capability)
 Sample Access Maps: RHU and Private

Travel time

Department of Health, Philippines

 Sample Access Maps: L3 Hospitals

Travel time

Department of Health, Philippines

 Draft
Standards Apex Hospital
To be assigned per
network by DOH based on
the Philippine Health
Within L3; Highest level comprehensive Facility Development Plan
Facility medical care in region

Within
Gatekeeping to national specialty centers, other specialty centers (including private), with
Specialty reimbursement implications
Network
APEX SPECIALTY
HOSPITAL SERVICES

REFERRAL M&E

Within
Network
Oversees referral mechanism of primary care Creates referral mechanism to other Teaching, training, and research Monitors
facilities to apex hospital specialty centers, wholesale hub of region performance of
procurement, distribution hub for health care
networks with CHD provider
networks
attached 73
 Draft
Standards Network Referral Mechanisms

Outpost
Comprehensive L1-L2 hospital Apex hospital
PC Facility

Ancillary Services Transition

Care Facility

74
 Draft
Standards Network Referral Components

Medical Monitoring and

M&E

Transportation Evaluation

Information and
Communication
Technology Resources Sharing
and Procurement

Referral
Mechanism Public Health
Roles
 SOURCING
RESOURCES Special Health Fund
• 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

 Outputs of the Strategic Planning Process
Network Network Network
Vision Analysis Arrangements

Catchment
Vision* Management structure
Strategies* Legal personality
Stakeholder analysis*
Milestones and Timeline* Decision making structure
Facility mapping
Strategic Planning Timeline and Facility network formation
Service capability mapping
Processes* Patient flow processes
HRH mapping
HRH plan

*First activity outputs Integrated investment plans

Monitoring and Evaluation

Department of Health, Philippines