UNIVERSAL HEALTH CARE

KALUSUGAN PARA SA LAHAT (RA-112233)

PGI : Nicasio, L. F.
 REPUBLIC ACT No. 11223

An Act Instituting Universal Health Care for All Filipinos,

Prescribing Reforms in the Health Care System, and
Appropriating Funds Therefor
“By automatically [enrolling] our citizens into
the National Health Insurance Program and
expanding PhilHealth coverage to include free
medical consultations and laboratory tests,
the Universal Healthcare Law that I signed
today will guarantee equitable access to
quality and a ordable healthcare services for
all Filipinos”
- President Rodrigo Duterte
February 20, 2019
 CHAPTER I :
GENERAL PROVISIONS
Section 1-2 : "Universal Health Care Act"
It is the policy of the State to protect and promote the right to health of all
Filipinos and instill health consciousness among them. Towards this end, the
State shall adopt:

(a) An integrated and comprehensive approach to ensure that all Filipinos are
health literate, provided with healthy living conditions, and protected from
hazards and risks that could affect their health;

(b) A health care model that provides all Filipinos access to a comprehensive
set of quality and cost-effective, promotive, preventive, curative, rehabilitative
and palliative health services without causing financial hardship,, and
prioritizes the needs of the population who cannot afford such services;

(c) A framework that fosters a whole-of-system, whole-of-government, and

whole-of-society approach in the development, implementation, monitoring,
and evaluation of health policies, programs and plans; and

(d) A people-oriented approach for the delivery of health services that is

centered on people’s needs and well-being, and cognizant of the differences in
culture, values, and beliefs.
Section 3 : General Objectives

(a) Progressively realize universal health care in the country

through a systemic approach and clear delineation of roles of
key agencies and stakeholders towards better performance
in the health system; and

(b) Ensure that all Filipinos are guaranteed equitable access

to quality and affordable health care goods and services, and
protected against financial risk.
 CHAPTER II :
UNIVERSAL HEALTH CARE (UHC)
Section 5-7 :

Section 5 :
Population Coverage

Section 6 :
Service Coverage

Section 7 :
Financial Coverage
Section 5 : Population Coverage

Every Filipino citizen shall be automatically

included into the NHIP, hereinafter referred to
as the Program.

National Health Insurance Program (NHIP)

The program aims to provide health insurance
coverage and ensures access to cost-effective
and quality health care services for all
Filipinos
Section 6 : Service Coverage
(a) Every Filipino shall be granted immediate eligibility and access to
preventive, promotive, curative, rehabilitative, and palliative care for medical,
dental, mental and emergency health services.

(b) Within two (2) years from the effectivity of this Act, PhilHealth shall
implement a comprehensive outpatient benefit, including outpatient drug
benefit and emergency medical services in accordance with the
recommendations of the Health Technology Assessment Council (HTAC)

(c) The DOH and the local government units (LGUs) shall endeavor to provide a
health care delivery system that will afford every Filipino a primary care
provider that would act as the navigator, coordinator, and initial and
continuing point of contact.

(d) Every Filipino shall register with a public or private primary care provider of
choice.
Section 7 : Financial Coverage
(a) Population-based health services shall be financed by the
National Government through the DOH and provided free of
charge at point of service for all Filipinos.

The National Government shall support LGUs in the financing

of capital investments and provision of population-based
interventions.

(b) Individual-based health services shall be financed

primarily through prepayment mechanisms such as social
health insurance, private health insurance, and HMO plans to
ensure predictability of health expenditures
 CHAPTER III :
NATIONAL HEALTH INSURANCE PROGRAM
Section 8 : Program Membership
Membership into the Program shall be simplified into two (2)
types, direct contributors and indirect contributors, as
defined in Section 4 of this Act.

1. Direct Contributors
- All Filipinos aged 21 years and above who have the capacity to
pay premiums. Gainfully employed – and are bound by an
employer- employee relationship or are Self-earning
individuals, professional practitioners
- Migrant workers including their qualified dependents
2. Indirect Contributors
- Those whose premium subsidized by the national government.
- Senior citizens who are not currently covered by the Program.
Persons with disability.
- All Filipinos aged 21 years old and above without the capacity
to pay premiums
Section 9 : Entitlement to Benefits
Every member shall be granted immediate eligibility for
health benefit package under the Program:

1. Provided, That PhilHealth Identification Card shall not be

required in the availment of any health service
2. Provided, further, That no co-payment shall be charged
for services rendered in basic or ward accommodation
3. Provided, furthermore, That copayments and
coinsurance for amenities in public hospitals shall be
regulated by the DOH and PhilHealth:
4. Provided, finally, That the current PhilHealth package for
members shall not be reduced.
Section 10 : Premium Contributions
(a) Population-based health services shall be financed by the
National Government through the DOH and provided free of
charge at point of service for all Filipinos.

The National Government shall support LGUs in the financing

of capital investments and provision of population-based
interventions.

(b) Individual-based health services shall be financed

primarily through prepayment mechanisms such as social
health insurance, private health insurance, and HMO plans to
ensure predictability of health expenditures
 CHAPTER IV :
HEALTH SERVICES DELIVERY
Section 17 : Population-based Health Services
The DOH shall endeavor to contract province-wide and
city-wide health systems for the delivery of
population-based health services. Province-wide and
city-wide health systems shall have the following minimum
components:

(a) Primary care provider network with patient records

accessible throughout the health system;

(b) Accurate, sensitive, and timely epidemiologic surveillance

systems; and

(c) Proactive and effective health promotion programs or

campaigns.
Section 18 : Individual-based Health Services

(a) PhilHealth shall endeavor to contract

public, private, or mixed health care provider
networks for the delivery of individual-based
health services

(b) PhilHealth shall endeavor to shift to

paying providers using performance-driven,
close-end, prospective payments based on
disease or diagnosis related groupings and
validated costing methodologies and without
differentiating facility and professional fees
 CHAPTER V :
ORGANIZATION OF LOCAL HEALTH SYSTEMS
Integration of Local Health Systems into
Province-wide and City-wide Health System
The local health system refers to all health offices, facilities
and services, human resources,and other operations relating
to health under the management of the LGUs to promote,
restore or maintain health

The DOH, DILG, PhilHealth, and LGUs shall endeavor to

integrate all local health systems into province-wide health
system and city-wide health system
 CHAPTER VI :
HUMAN RESOURCES FOR HEALTH
Section 18 : Individual-based Health Services
National Health Human Resource Master Plan. - The DOH, together with
stakeholders, shall ensure the formulation and implementation of a National
Health Human Resource Master Plan that will provide policies and strategies
for the appropriate generation, recruitment, retraining, regulation, retention
and reassessment of health workforce based on population health needs.

National Health Workforce Support System. - A national health workforce

(NHW) support system shall be created to support local public health systems
in addressing their human resource needs: Provided, That deployment to
Geographically Isolated and Disadvantaged Areas (GIDAs) shall be prioritized.

Scholarship and Training Program. - The Commission on Higher Education

(CHED), Technical Education and Skills Development Authority (TESDA),
Professional Regulation Commission (PRC) and the DOH shall develop and plan
the expansion of existing and new allied and health-related degree and
training programs including those for community-based health care workers
and regulate the number of enrollees in each program based on the health
needs of the population especially those in underserved areas.
CHAPTER VII :
REGULATION
Safety and Quality
- Philhealth shall establish a rating system under an incentive
scheme to acknowledge and reward health facilities that
provide better service quality, efficiency and equity
- The DOH shall institute a licensing and regulatory system for
stand alone health facilities, including primary care facilities.
Affordability
- Mandating transparent pricing of health goods and services.
Independent price negotiation board, to negotiate prices on
behalf of the DOH and PhilHealth
Equity
- The DOH shall annually update its list of underserved areas,
which shall be the basis for preferential licensing of health
facilities and contracting of health services.
- The government shall guarantee that the distribution of health
services and benefits provided for in this Act shall be equitable
by prioritizing GIDAs in the provision of assistance and support.
 CHAPTER VII :
GOVERNANCE AND ACCOUNTABILITY
Health Promotion
- Increasing health literacy with focus on reducing non-communicable
diseases, implement population-wide health promotion programs and
activities to ensure the attainment of the framework strategy and its
programs to promote and to provide technical support to local Research
and development programs and projects

Evidence-Informed Sectoral Policy and Planning for UHC

- All public and private, national and local health-related entities shall be
required to submit health and health-related data to PhilHealth including
information about administrative, public health, medical, pharmaceutical
and health financing data.

Monitoring and Evaluation

- The Philippine Statistics Authority (PSA) shall conduct the relevant
modules of household surveys in coordination with DOH annually during
the first ten (10) years of the implementation, and thereafter follow its
regular schedule.

Health Impact Assessment (HIA).

- HIA shall be required for policies, programs, and projects that are crucial in
attaining better health outcomes or those that may have an impact on the
health sector.
 CHAPTER IX :
APPROPRIATIONS
The amount necessary to implement this Act shall be sourced from the
following:

(a) Total incremental sin tax collections as provided for in Republic Act No.
10351, otherwise known as the "Sin Tax Reform Law"

(b) Fifty percent (50%) of the National Government share from the income of
the Philippine Amusement Gaming Corporation (PAGCOR) as provided for in
Presidential Decree No. 1869, as amended

(c) Forty percent (40%) of the Charity Fund, net of Documentary Stamp Tax
Payments, and mandatory contributions of the Philippine Charity
Sweepstakes Office (PCSO) as provided for in Republic Act No. 1169, as
amended

(d) Premium contributions of members;

(e) Annual appropriations of the DOH included in the GAA; and

(f ) National Government subsidy to PhilHealth included in the GAA.

KEY POINTS
Key Benefits of UHC Act:
1. Equitable Access : Eliminating financial barriers and
ensuring healthcare access for all Filipinos. Reducing
health disparities and promoting health equity
2. Quality Healthcare Services : Emphasizing the delivery of
high-quality healthcare services to all individuals.
3. Preventive and Promotive Health : Focus on health
promotion, disease prevention, and early detection.
Improving population health and reducing
healthcare costs in the long term
4. Coordinated and Integrated Care : Enhanced coordination
among healthcare providers for better continuity
of care.
QUIZ
1. What is RA 112233?
2. What National Health Insurance Program was shown in the discussion?
3. All Filipinos aged 21 years old and above without the capacity to pay
premiums
4. Who passed the Law
5. When was it passed
QUIZ
1. What is RA 112233? Universal Health Care Act
2. What National Health Insurance Program was shown in the discussion?
Philhealth
3. All Filipinos aged 21 years old and above without the capacity to pay
premiums Indirect Contributor
4. Who passed the UHC Law President Rodrigo Duterte
5. When was it passed Feb 20 2019