152 Questions
What is the title of the law that institutes Universal Health Care for all Filipinos?
Republic Act 11223
Who signed the Implementing Rules and Regulations of the Universal Health Care Act?
Francisco T. Duque III
What is the primary objective of the Universal Health Care Act?
To ensure equitable access to quality and affordable healthcare
How many key declarations of principles are stated in the Universal Health Care Act?
4
What is one of the dimensions of coverage in the Universal Health Care framework?
Financial protection
What is the approach envisioned in the Universal Health Care Act?
People-oriented approach
How many general provisions are outlined in the Universal Health Care Act?
11
What is the goal of the Universal Health Care Act in terms of healthcare access?
To ensure equitable access to quality and affordable healthcare
What is the minimum component of population-based health services that involves monitoring and analyzing health data?
Disease surveillance and epidemiology system
What is the purpose of PhilHealth contracting public-private healthcare provider networks?
To agree on service quality and standards of care
What type of payment scheme is PhilHealth shifting towards?
Performance-driven, close-end, prospective payments
What is the purpose of the special health fund?
To pool health funds at the local level
What is the requirement for accessing higher levels of care under the Universal Healthcare Act?
Primary care services
What is the purpose of the National Human Resource for Health Master Plan?
To provide policies and strategies for health workforce based on population needs
What is the role of provincial or city health boards in local health systems?
To oversee and coordinate health services
What is the requirement for healthcare provider networks under the Universal Healthcare Act?
To be linked to a apex hospital
What is the purpose of the framework of Universal Healthcare?
To institutionalize healthcare provider networks
What is the role of municipalities and cities in local health systems?
To commit to integrate their health system
What is the main concern of the first dimension of healthcare coverage?
Who is eligible for healthcare services
What type of health services are financed by the DOH and LGUs?
Population-based health services
Who are considered direct contributors to PhilHealth?
Those who have the capacity to pay premiums
What is the purpose of the program reserve funds in PhilHealth?
To derive accumulated revenues not needed to meet the cost of the current year's expenditure
What is the limit of administrative expenses of the Philippine Health Insurance Corporation?
7.5% of the actual premium collected
What is the composition of the PhilHealth Board of Directors?
A maximum of 13 members
What is the benefit of being a PhilHealth member?
Immediate eligibility to access healthcare services
What is the source of funding for indirect contributors to PhilHealth?
National government
What is the purpose of pooling funds to PhilHealth?
To provide healthcare services to all Filipinos
What is the benefit of having no co-payment in basic or service ward accommodation?
No out-of-pocket expenditure for health
What is the requirement for government-funded scholars under the Return Service Agreement?
Return service for at least three years
What is the goal of the reorientation of health professional education?
To focus on primary care services
What is the purpose of the registry of medical and allied health professionals?
To track health professionals' licenses and certifications
What is the goal of PhilHealth's recognition of a third party accreditation mechanism?
To improve healthcare quality
What is the purpose of the rating system in PhilHealth?
To evaluate healthcare quality
What is the minimum accommodation requirement for government hospitals?
At least 90%
What is the purpose of benefit complementation between DOH, PhilHealth, PHIs, and HMOs?
To promote healthcare affordability
What is the purpose of the Health Technology Assessment (HTA) process?
To evaluate the effectiveness of healthcare technologies
What is the purpose of the Health Impact Assessment?
To evaluate the impact of healthcare projects
What is the main objective of Universal Health Coverage?
To ensure everyone obtains the health care they need without financial hardship
What is the purpose of the Health Information System?
To track healthcare data and information
What is the goal of increasing health care to people while decreasing their out-of-pocket expenditure?
To achieve Universal Health Coverage
What are the three dimensions of improving Universal Health Coverage according to the WHO 'cube' diagram?
Population coverage, service coverage, and financial coverage
What is the ultimate goal of increasing the scope of services paid for from pooled financing?
To achieve Universal Health Coverage
What is required to ensure that people get the health care they need?
Effective availability of services
What is the fourth dimension of Universal Health Coverage?
Quality of care
What is the purpose of PhilHealth outsourcing certain functions?
To ensure fulfillment of the Act in the first 10 years
What is the goal of managerial integration of province-wide and city-wide systems?
To improve operational efficiency
What is the purpose of the Performance Monitoring Division?
To monitor and evaluate the implementation of UHC
What is one of the sources of funding for Universal Health Care?
Total incremental sin tax collections
What is 'pseudo coverage' in the context of universal health care?
Having health insurance without access to health services
What is the main objective of improving health services financed by taxation?
To advance universal health care by increasing access to quality health services
What is one of the strategic objectives of universal health care?
To attain greater efficiency in the health care system
What is covered under population coverage in the UHC Act?
Every Filipino citizen through automatic inclusion in the National Health Insurance Program
What is included in service coverage in the UHC Act?
Immediate eligibility and access to population-based and individual-based health services
What is a characteristic of a health care provider network?
A group of primary to tertiary care providers offering comprehensive people-centered care
What is the role of the Provincial or City Health Board?
To set the overall health policy directions and strategic thrusts
What is a principle of primary care?
People-centeredness through empowerment of individuals to make decisions related to their health
What is a strategic thrust of primary care?
Integrated and comprehensive primary care
What is a component of health care provider networks?
Provincial or City Health Board and Support Units
What is one of the approaches to expanding availability and accessibility of primary care services?
Building or upgrading health centers and barangay health stations
What is a way to enhance quality of primary care services?
Certifying primary care workers
What is a characteristic of individual-based health services?
They are excludable
What is a characteristic of population-based health services?
They are non-rival and non-excludable
What is an example of strengthening health services in geographically isolated and disadvantaged areas?
Identifying GIDAs
What is an objective of improving demand generation and healthcare utilization?
Improving health literacy
What is a way to strengthen care coordination and referral mechanisms?
Developing care coordination and two-way referral systems
What is a characteristic of individual-based health services?
They are rival
What is a way to expand primary care health packages?
Providing essential equipment and supplies
What is a characteristic of population-based health services?
They have external effects
What is a characteristic of population-based health services?
Have an effect that extends beyond the well-being of one person
What is an example of a population-based health service?
Disaster risk reduction and management in health
How are population-based health services primarily funded?
By the national government in complementation with LGU budget for health
What is a characteristic of individual-based health services?
Can be traced back to a single beneficiary
What is an example of an individual-based health service?
Primary care benefit package
How are individual-based health services primarily funded?
Through social health insurance in complementation with private health insurance and HMOs
What is a source of funding for Universal Health Care?
Premium contributions of members
What is the purpose of the Special Health Fund?
To support health programs and projects
The Universal Health Care Act aims to ensure equitable access to quality and affordable healthcare without causing financial hardship to all citizens.
True
The Universal Health Care Act has a total of 12 key provisions.
False
The Universal Health Care Act adopts a universal health coverage framework of the World Health Organization.
True
The Universal Health Care Act was signed into law by Rodrigo Duterte on October 20, 2019.
False
The Universal Health Care Act has four key declarations of principles.
True
The Universal Health Care Act aims to ensure healthcare access only to the poor and marginalized members of society.
False
The Universal Health Care Act has a whole-of-government approach in the development of health policies.
True
The Universal Health Care Act envisions a progressive realization of universal healthcare through a fragmented approach.
False
All Filipinos are automatically included in the National Health Insurance Program.
True
The Universal Healthcare Act only covers population-based health services.
False
The payment of PhilHealth premium for indirect contributors will be subsidized by the national government.
True
Co-payment will not apply to patients who prefer to avail of additional amenities over and above basic accommodation.
False
The PhilHealth Board of Directors will be composed of a minimum of 13 members.
False
All PhilHealth personnel are considered as public health workers.
True
The purpose of the program reserve funds is to meet the cost of the current year's expenditure.
False
Administrative expenses of the Philippine Health Insurance Corporation should not be more than 10% of the actual premium collected.
False
Premium rates for indirect contributors will be gradually adjusted and reflected annually in the GAA.
True
The National Health Insurance Program has a simplification of NHIP membership.
True
The Return Service Agreement requires government-funded scholars to render at least five years of service.
False
The Scholarship and Training Program aims to reorient health professional education, certification, and regulation for provision of specialized care services.
False
PhilHealth recognizes a second-party accreditation mechanism.
False
The rating system in PhilHealth is established by the DOH.
False
At least 80% of government hospitals are required to have basic accommodation.
False
The Independent Price Negotiation Board negotiates prices on behalf of the LGUs.
False
The Health Promotion Bureau is established under the DOH.
True
The Health Technology Assessment (HTA) process is institutionalized within the DOST.
False
The Health Information System is developed and funded by the LGUs.
False
The Public Health Ethics Committee is an advisory body to the Secretary of Education.
False
Population-based health services provided by the DOH include disease surveillance and epidemiology systems.
True
PhilHealth will be contracting public-private healthcare provider networks that agree on co-payment mechanisms only.
False
Universal Health Coverage seeks to ensure that everyone obtains the health care they need without financial hardship.
True
Apex or end-repair hospitals are not considered as stand-alone healthcare providers.
False
The three dimensions of improving Universal Health Coverage are population, service, and quality coverage.
False
PhilHealth is required to outsource certain functions to ensure operational efficiency and fulfillment of the Act in the first 5 years.
False
The Universal Health Care Act mandates the government to institutionalize healthcare provider networks composed of public health facilities only.
False
Primary care is not a prerequisite for accessing higher levels of care under the Universal Healthcare Act.
False
The creation of a Joint Congressional Oversight Committee on UHC is an oversight provision.
True
Province-wide and city-wide health systems are not mandated to pool and manage all financial resources in their respective special health funds.
False
Total incremental sin tax collections are not a source of funding for Universal Health Coverage.
False
Managerial integration of province-wide and city-wide systems is expected to be achieved within the first 5 years.
False
The National Human Resource for Health Master Plan is to provide policies and strategies for health workforce based on population needs.
True
PhilHealth is not shifting towards paying providers using performance-driven, close-end, prospective payments.
False
The Performance Monitoring Division is not responsible for monitoring and evaluating the implementation of Universal Health Coverage.
False
The integration of all local health systems is expected to be achieved through a legislative act.
False
Provincial or city health boards do not oversee and coordinate the integration and delivery of health services across the healthcare continuum.
False
The National Government subsidy to PhilHealth is not a source of funding for Universal Health Coverage.
False
Municipalities and cities are not entitled to representations to local health boards if they commit to integrate their health system.
False
Quality of care is not a dimension of Universal Health Coverage.
False
Expanding primary care health packages is a way to enhance the quality of primary care services.
False
Establishing linkages to apex hospitals is a way to strengthen care coordination and referral mechanisms.
True
Registering citizens to a primary care provider is a way to improve health literacy.
False
Individual-based health services are non-rival.
False
Population-based health services have external effects.
True
Licensing primary care facilities is a way to expand the availability and accessibility of primary care services.
False
Providing ambulances and patient transport services is a way to strengthen care coordination and referral mechanisms.
True
Identifying GIDAs is a way to strengthen health services in geographically isolated and disadvantaged areas.
True
Improving health literacy is a way to strengthen care coordination and referral mechanisms.
False
Population-based health services are excludable.
False
Every Filipino citizen is automatically included in the National Health Insurance Program under the UHC Act.
True
The primary objective of the Universal Health Care Act is to reduce healthcare costs.
False
A Health Care Provider Network is a group of only private healthcare providers.
False
Primary care providers act as navigators and coordinators of healthcare within the Health Care Provider Network.
True
The Provincial or City Health Board oversees the integration and delivery of health services.
True
Primary Health Care is not a guiding philosophy and approach in the Universal Health Care Act.
False
Improving health services financed by taxation can advance Universal Health Coverage.
True
The purpose of the Special Health Fund is to allocate funds for health research and development.
False
The UHC Act aims to reduce the out-of-pocket expenditure of individuals for healthcare services.
True
Providing health insurance to people without health services being available is an example of 'pseudo coverage'.
True
Health services that have population groups as recipients are considered individual-based health services.
False
PhilHealth is a primary financier of population-based health services.
False
Disaster risk reduction and management in health is an example of individual-based health services.
False
The national government share from PAGCOR is a source of funding for UHC.
True
The LGU Health Scorecard is used to assess the performance of individual-based health services.
False
Out-patient benefit packages are an example of population-based health services.
False
The special health fund is used to finance individual-based health services.
False
The rating system is used to assess the performance of health facilities in the local health system.
True
Study Notes
Universal Health Coverage (UHC) Framework
- UHC is about ensuring everyone has access to quality healthcare without financial hardship.
- Three ways to move towards UHC:
- Increase population coverage (who is covered?)
- Expand service coverage (which services are covered?)
- Increase financial coverage (what proportion of cost is covered?)
- The WHO 'Cube' diagram illustrates the three dimensions of improving UHC:
- Population coverage
- Service coverage
- Financial coverage
Universal Health Care Act (RA 11223)
- Signed into law by President Rodrigo Duterte on February 20, 2019
- Implementing Rules and Regulations (IRR) signed by DOH Secretary Francisco Duque III on October 20, 2019
- Key provisions:
- Universal Health Care Coverage
- National Health Insurance Program (NHIP)
- Health Services Delivery
- Organizational Structure of Local Health Systems
- Human Resources for Health
- Regulation
- Governance and Accountability
- Appropriations
- Penal Provisions
- Miscellaneous Provisions
UHC Coverage
- Population coverage:
- All Filipinos are automatically included in the National Health Insurance Program (NHIP)
- Service coverage:
- Two groups of healthcare packages:
- Population-based health services (financed by national government and provided free at point of service)
- Individual-based health services (financed primarily through social health insurance, PhilHealth)
- Two groups of healthcare packages:
- Financial coverage:
- Reducing out-of-pocket expenditure for health
Health Services Delivery
- Population-based health services:
- Financed by DOH in complementation with LGU budget
- Provided free at point of service
- Individual-based health services:
- Financed primarily through social health insurance (PhilHealth)
- In complementation with private health insurance and health maintenance organizations (HMOs)
Organizational Structure of Local Health Systems
- Consolidation of providers into health systems:
- Province-wide and city-wide health systems
- Managed by Provincial or City Health Boards
- Oversee and coordinate integration and delivery of health services across the healthcare continuum
- Manage the Special Health Fund (SHF)
Human Resources for Health
- National Human Resource for Health Master Plan:
- Provide appropriate policies and strategies for health workforce based on population needs
- Ensure permanent employment and competitive salaries
- Return Service Agreement:
- Establish guidelines for non-compliance
- Provide additional incentives for those rendering additional two years of service
- Return service for at least three years for government-funded scholars
Regulation
- Safety and Quality:
- PhilHealth to recognize third-party accreditation mechanism
- Establishment of a rating system in PhilHealth
- DOH to set standards for clinical care
- Equity:
- Equitable distribution of health services and benefits prioritizing underserved areas
- Preferential licensing of health facilities and contracting of health services for underserved areas
Governance and Accountability
-
Formulation of strategy for health literacy
-
Policy coordination across government instrumentalities
-
Health promotion programs and activities across social determinants of health
-
Technical support to local research and development
-
Incorporation of health promotion in school curricula### Expanding Primary Care Services
-
Building or upgrading health centers and barangay health stations to increase availability and accessibility of primary care services
-
Enhancing and tapping capacity of private primary care providers
-
Expanding primary care health packages
-
Providing essential equipment and supplies
-
Establishing mobile and telehealth services
Enhancing Quality of Primary Care Services
- Licensing primary care facilities
- Accrediting providers to deliver primary care benefit package
- Certifying primary care workers
- Utilizing clinical practice guidelines
- Implementing continuous quality improvement
Strengthening Care Coordination and Referral Mechanisms
- Developing care coordination and two-way referral systems
- Providing ambulances and patient transport services
- Improving capacity of level 1 hospitals
- Expanding capacity of level 2 or 3 hospitals
- Establishing linkages to apex hospitals
Improving Demand Generation and Healthcare Utilization
- Improving health literacy
- Communicating citizens' health entitlement
- Enhancing health-seeking behavior
- Registering citizens to a primary care provider
- Expanding social support system
Strengthening Health Services in Geographically Isolated and Disadvantaged Areas (GIDAs)
- Identifying GIDAs based on physical (isolated) and socioeconomic factors (disadvantaged)
- Profiling GIDAs
- Scoring system for prioritization
- Monitoring system to determine health status and gaps
- Preferential licensing for health facilities in GIDAs
Delivering Population-Based and Individual-Based Health Services
- Population-based health services: health interventions with population groups as recipients, no tracing back to a single beneficiary, and effect extends beyond one person
- Funded by the national government (DOH) in complementation with LGU budget for health
- Services include health promotion programs, epidemiology and disease surveillance system, disaster risk reduction and management in health
Financing Local Health Services
- Sources of funding for Universal Health Care (UHC) include incremental sin tax collections, Pagcor share, charity fund, and premium contributions of members
- Financing individual-based health services through social health insurance (PhilHealth) and private health insurance and HMOs
Universal Health Coverage (UHC) Framework
- UHC is about ensuring everyone has access to quality healthcare without financial hardship.
- Three ways to move towards UHC:
- Increase population coverage (who is covered?)
- Expand service coverage (which services are covered?)
- Increase financial coverage (what proportion of cost is covered?)
- The WHO 'Cube' diagram illustrates the three dimensions of improving UHC:
- Population coverage
- Service coverage
- Financial coverage
Universal Health Care Act (RA 11223)
- Signed into law by President Rodrigo Duterte on February 20, 2019
- Implementing Rules and Regulations (IRR) signed by DOH Secretary Francisco Duque III on October 20, 2019
- Key provisions:
- Universal Health Care Coverage
- National Health Insurance Program (NHIP)
- Health Services Delivery
- Organizational Structure of Local Health Systems
- Human Resources for Health
- Regulation
- Governance and Accountability
- Appropriations
- Penal Provisions
- Miscellaneous Provisions
UHC Coverage
- Population coverage:
- All Filipinos are automatically included in the National Health Insurance Program (NHIP)
- Service coverage:
- Two groups of healthcare packages:
- Population-based health services (financed by national government and provided free at point of service)
- Individual-based health services (financed primarily through social health insurance, PhilHealth)
- Two groups of healthcare packages:
- Financial coverage:
- Reducing out-of-pocket expenditure for health
Health Services Delivery
- Population-based health services:
- Financed by DOH in complementation with LGU budget
- Provided free at point of service
- Individual-based health services:
- Financed primarily through social health insurance (PhilHealth)
- In complementation with private health insurance and health maintenance organizations (HMOs)
Organizational Structure of Local Health Systems
- Consolidation of providers into health systems:
- Province-wide and city-wide health systems
- Managed by Provincial or City Health Boards
- Oversee and coordinate integration and delivery of health services across the healthcare continuum
- Manage the Special Health Fund (SHF)
Human Resources for Health
- National Human Resource for Health Master Plan:
- Provide appropriate policies and strategies for health workforce based on population needs
- Ensure permanent employment and competitive salaries
- Return Service Agreement:
- Establish guidelines for non-compliance
- Provide additional incentives for those rendering additional two years of service
- Return service for at least three years for government-funded scholars
Regulation
- Safety and Quality:
- PhilHealth to recognize third-party accreditation mechanism
- Establishment of a rating system in PhilHealth
- DOH to set standards for clinical care
- Equity:
- Equitable distribution of health services and benefits prioritizing underserved areas
- Preferential licensing of health facilities and contracting of health services for underserved areas
Governance and Accountability
-
Formulation of strategy for health literacy
-
Policy coordination across government instrumentalities
-
Health promotion programs and activities across social determinants of health
-
Technical support to local research and development
-
Incorporation of health promotion in school curricula### Expanding Primary Care Services
-
Building or upgrading health centers and barangay health stations to increase availability and accessibility of primary care services
-
Enhancing and tapping capacity of private primary care providers
-
Expanding primary care health packages
-
Providing essential equipment and supplies
-
Establishing mobile and telehealth services
Enhancing Quality of Primary Care Services
- Licensing primary care facilities
- Accrediting providers to deliver primary care benefit package
- Certifying primary care workers
- Utilizing clinical practice guidelines
- Implementing continuous quality improvement
Strengthening Care Coordination and Referral Mechanisms
- Developing care coordination and two-way referral systems
- Providing ambulances and patient transport services
- Improving capacity of level 1 hospitals
- Expanding capacity of level 2 or 3 hospitals
- Establishing linkages to apex hospitals
Improving Demand Generation and Healthcare Utilization
- Improving health literacy
- Communicating citizens' health entitlement
- Enhancing health-seeking behavior
- Registering citizens to a primary care provider
- Expanding social support system
Strengthening Health Services in Geographically Isolated and Disadvantaged Areas (GIDAs)
- Identifying GIDAs based on physical (isolated) and socioeconomic factors (disadvantaged)
- Profiling GIDAs
- Scoring system for prioritization
- Monitoring system to determine health status and gaps
- Preferential licensing for health facilities in GIDAs
Delivering Population-Based and Individual-Based Health Services
- Population-based health services: health interventions with population groups as recipients, no tracing back to a single beneficiary, and effect extends beyond one person
- Funded by the national government (DOH) in complementation with LGU budget for health
- Services include health promotion programs, epidemiology and disease surveillance system, disaster risk reduction and management in health
Financing Local Health Services
- Sources of funding for Universal Health Care (UHC) include incremental sin tax collections, Pagcor share, charity fund, and premium contributions of members
- Financing individual-based health services through social health insurance (PhilHealth) and private health insurance and HMOs
Understanding the framework and mandates of the Universal Health Care Act in the Philippines, covering its key provisions and implementing rules.
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