Management and Governance Paradigms in Health (SGHMANGOV) - UHC Act Philippines
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Questions and Answers

What is the title of the law that institutes Universal Health Care for all Filipinos?

  • Republic Act 11223 (correct)
  • Universal Health Care Act
  • Republic Act 11123
  • Republic Act 11323

    • Who signed the Implementing Rules and Regulations of the Universal Health Care Act?

  • Francisco T. Duque III (correct)
  • Vladimir Ramon Fr. Puno
  • Rodrigo Duterte
  • Juan Miguel Zubiri

    • What is the primary objective of the Universal Health Care Act?

  • To increase healthcare taxes
  • To reduce healthcare costs for the rich
  • To promote private healthcare services
  • To ensure equitable access to quality and affordable healthcare (correct)

    • How many key declarations of principles are stated in the Universal Health Care Act?

    <p>4</p> Signup and view all the answers

    What is one of the dimensions of coverage in the Universal Health Care framework?

    <p>Financial protection</p> Signup and view all the answers

    What is the approach envisioned in the Universal Health Care Act?

    <p>People-oriented approach</p> Signup and view all the answers

    How many general provisions are outlined in the Universal Health Care Act?

    <p>11</p> Signup and view all the answers

    What is the goal of the Universal Health Care Act in terms of healthcare access?

    <p>To ensure equitable access to quality and affordable healthcare</p> Signup and view all the answers

    What is the minimum component of population-based health services that involves monitoring and analyzing health data?

    <p>Disease surveillance and epidemiology system</p> Signup and view all the answers

    What is the purpose of PhilHealth contracting public-private healthcare provider networks?

    <p>To agree on service quality and standards of care</p> Signup and view all the answers

    What type of payment scheme is PhilHealth shifting towards?

    <p>Performance-driven, close-end, prospective payments</p> Signup and view all the answers

    What is the purpose of the special health fund?

    <p>To pool health funds at the local level</p> Signup and view all the answers

    What is the requirement for accessing higher levels of care under the Universal Healthcare Act?

    <p>Primary care services</p> Signup and view all the answers

    What is the purpose of the National Human Resource for Health Master Plan?

    <p>To provide policies and strategies for health workforce based on population needs</p> Signup and view all the answers

    What is the role of provincial or city health boards in local health systems?

    <p>To oversee and coordinate health services</p> Signup and view all the answers

    What is the requirement for healthcare provider networks under the Universal Healthcare Act?

    <p>To be linked to a apex hospital</p> Signup and view all the answers

    What is the purpose of the framework of Universal Healthcare?

    <p>To institutionalize healthcare provider networks</p> Signup and view all the answers

    What is the role of municipalities and cities in local health systems?

    <p>To commit to integrate their health system</p> Signup and view all the answers

    What is the main concern of the first dimension of healthcare coverage?

    <p>Who is eligible for healthcare services</p> Signup and view all the answers

    What type of health services are financed by the DOH and LGUs?

    <p>Population-based health services</p> Signup and view all the answers

    Who are considered direct contributors to PhilHealth?

    <p>Those who have the capacity to pay premiums</p> Signup and view all the answers

    What is the purpose of the program reserve funds in PhilHealth?

    <p>To derive accumulated revenues not needed to meet the cost of the current year's expenditure</p> Signup and view all the answers

    What is the limit of administrative expenses of the Philippine Health Insurance Corporation?

    <p>7.5% of the actual premium collected</p> Signup and view all the answers

    What is the composition of the PhilHealth Board of Directors?

    <p>A maximum of 13 members</p> Signup and view all the answers

    What is the benefit of being a PhilHealth member?

    <p>Immediate eligibility to access healthcare services</p> Signup and view all the answers

    What is the source of funding for indirect contributors to PhilHealth?

    <p>National government</p> Signup and view all the answers

    What is the purpose of pooling funds to PhilHealth?

    <p>To provide healthcare services to all Filipinos</p> Signup and view all the answers

    What is the benefit of having no co-payment in basic or service ward accommodation?

    <p>No out-of-pocket expenditure for health</p> Signup and view all the answers

    What is the requirement for government-funded scholars under the Return Service Agreement?

    <p>Return service for at least three years</p> Signup and view all the answers

    What is the goal of the reorientation of health professional education?

    <p>To focus on primary care services</p> Signup and view all the answers

    What is the purpose of the registry of medical and allied health professionals?

    <p>To track health professionals' licenses and certifications</p> Signup and view all the answers

    What is the goal of PhilHealth's recognition of a third party accreditation mechanism?

    <p>To improve healthcare quality</p> Signup and view all the answers

    What is the purpose of the rating system in PhilHealth?

    <p>To evaluate healthcare quality</p> Signup and view all the answers

    What is the minimum accommodation requirement for government hospitals?

    <p>At least 90%</p> Signup and view all the answers

    What is the purpose of benefit complementation between DOH, PhilHealth, PHIs, and HMOs?

    <p>To promote healthcare affordability</p> Signup and view all the answers

    What is the purpose of the Health Technology Assessment (HTA) process?

    <p>To evaluate the effectiveness of healthcare technologies</p> Signup and view all the answers

    What is the purpose of the Health Impact Assessment?

    <p>To evaluate the impact of healthcare projects</p> Signup and view all the answers

    What is the main objective of Universal Health Coverage?

    <p>To ensure everyone obtains the health care they need without financial hardship</p> Signup and view all the answers

    What is the purpose of the Health Information System?

    <p>To track healthcare data and information</p> Signup and view all the answers

    What is the goal of increasing health care to people while decreasing their out-of-pocket expenditure?

    <p>To achieve Universal Health Coverage</p> Signup and view all the answers

    What are the three dimensions of improving Universal Health Coverage according to the WHO 'cube' diagram?

    <p>Population coverage, service coverage, and financial coverage</p> Signup and view all the answers

    What is the ultimate goal of increasing the scope of services paid for from pooled financing?

    <p>To achieve Universal Health Coverage</p> Signup and view all the answers

    What is required to ensure that people get the health care they need?

    <p>Effective availability of services</p> Signup and view all the answers

    What is the fourth dimension of Universal Health Coverage?

    <p>Quality of care</p> Signup and view all the answers

    What is the purpose of PhilHealth outsourcing certain functions?

    <p>To ensure fulfillment of the Act in the first 10 years</p> Signup and view all the answers

    What is the goal of managerial integration of province-wide and city-wide systems?

    <p>To improve operational efficiency</p> Signup and view all the answers

    What is the purpose of the Performance Monitoring Division?

    <p>To monitor and evaluate the implementation of UHC</p> Signup and view all the answers

    What is one of the sources of funding for Universal Health Care?

    <p>Total incremental sin tax collections</p> Signup and view all the answers

    What is 'pseudo coverage' in the context of universal health care?

    <p>Having health insurance without access to health services</p> Signup and view all the answers

    What is the main objective of improving health services financed by taxation?

    <p>To advance universal health care by increasing access to quality health services</p> Signup and view all the answers

    What is one of the strategic objectives of universal health care?

    <p>To attain greater efficiency in the health care system</p> Signup and view all the answers

    What is covered under population coverage in the UHC Act?

    <p>Every Filipino citizen through automatic inclusion in the National Health Insurance Program</p> Signup and view all the answers

    What is included in service coverage in the UHC Act?

    <p>Immediate eligibility and access to population-based and individual-based health services</p> Signup and view all the answers

    What is a characteristic of a health care provider network?

    <p>A group of primary to tertiary care providers offering comprehensive people-centered care</p> Signup and view all the answers

    What is the role of the Provincial or City Health Board?

    <p>To set the overall health policy directions and strategic thrusts</p> Signup and view all the answers

    What is a principle of primary care?

    <p>People-centeredness through empowerment of individuals to make decisions related to their health</p> Signup and view all the answers

    What is a strategic thrust of primary care?

    <p>Integrated and comprehensive primary care</p> Signup and view all the answers

    What is a component of health care provider networks?

    <p>Provincial or City Health Board and Support Units</p> Signup and view all the answers

    What is one of the approaches to expanding availability and accessibility of primary care services?

    <p>Building or upgrading health centers and barangay health stations</p> Signup and view all the answers

    What is a way to enhance quality of primary care services?

    <p>Certifying primary care workers</p> Signup and view all the answers

    What is a characteristic of individual-based health services?

    <p>They are excludable</p> Signup and view all the answers

    What is a characteristic of population-based health services?

    <p>They are non-rival and non-excludable</p> Signup and view all the answers

    What is an example of strengthening health services in geographically isolated and disadvantaged areas?

    <p>Identifying GIDAs</p> Signup and view all the answers

    What is an objective of improving demand generation and healthcare utilization?

    <p>Improving health literacy</p> Signup and view all the answers

    What is a way to strengthen care coordination and referral mechanisms?

    <p>Developing care coordination and two-way referral systems</p> Signup and view all the answers

    What is a characteristic of individual-based health services?

    <p>They are rival</p> Signup and view all the answers

    What is a way to expand primary care health packages?

    <p>Providing essential equipment and supplies</p> Signup and view all the answers

    What is a characteristic of population-based health services?

    <p>They have external effects</p> Signup and view all the answers

    What is a characteristic of population-based health services?

    <p>Have an effect that extends beyond the well-being of one person</p> Signup and view all the answers

    What is an example of a population-based health service?

    <p>Disaster risk reduction and management in health</p> Signup and view all the answers

    How are population-based health services primarily funded?

    <p>By the national government in complementation with LGU budget for health</p> Signup and view all the answers

    What is a characteristic of individual-based health services?

    <p>Can be traced back to a single beneficiary</p> Signup and view all the answers

    What is an example of an individual-based health service?

    <p>Primary care benefit package</p> Signup and view all the answers

    How are individual-based health services primarily funded?

    <p>Through social health insurance in complementation with private health insurance and HMOs</p> Signup and view all the answers

    What is a source of funding for Universal Health Care?

    <p>Premium contributions of members</p> Signup and view all the answers

    What is the purpose of the Special Health Fund?

    <p>To support health programs and projects</p> Signup and view all the answers

    The Universal Health Care Act aims to ensure equitable access to quality and affordable healthcare without causing financial hardship to all citizens.

    <p>True</p> Signup and view all the answers

    The Universal Health Care Act has a total of 12 key provisions.

    <p>False</p> Signup and view all the answers

    The Universal Health Care Act adopts a universal health coverage framework of the World Health Organization.

    <p>True</p> Signup and view all the answers

    The Universal Health Care Act was signed into law by Rodrigo Duterte on October 20, 2019.

    <p>False</p> Signup and view all the answers

    The Universal Health Care Act has four key declarations of principles.

    <p>True</p> Signup and view all the answers

    The Universal Health Care Act aims to ensure healthcare access only to the poor and marginalized members of society.

    <p>False</p> Signup and view all the answers

    The Universal Health Care Act has a whole-of-government approach in the development of health policies.

    <p>True</p> Signup and view all the answers

    The Universal Health Care Act envisions a progressive realization of universal healthcare through a fragmented approach.

    <p>False</p> Signup and view all the answers

    All Filipinos are automatically included in the National Health Insurance Program.

    <p>True</p> Signup and view all the answers

    The Universal Healthcare Act only covers population-based health services.

    <p>False</p> Signup and view all the answers

    The payment of PhilHealth premium for indirect contributors will be subsidized by the national government.

    <p>True</p> Signup and view all the answers

    Co-payment will not apply to patients who prefer to avail of additional amenities over and above basic accommodation.

    <p>False</p> Signup and view all the answers

    The PhilHealth Board of Directors will be composed of a minimum of 13 members.

    <p>False</p> Signup and view all the answers

    All PhilHealth personnel are considered as public health workers.

    <p>True</p> Signup and view all the answers

    The purpose of the program reserve funds is to meet the cost of the current year's expenditure.

    <p>False</p> Signup and view all the answers

    Administrative expenses of the Philippine Health Insurance Corporation should not be more than 10% of the actual premium collected.

    <p>False</p> Signup and view all the answers

    Premium rates for indirect contributors will be gradually adjusted and reflected annually in the GAA.

    <p>True</p> Signup and view all the answers

    The National Health Insurance Program has a simplification of NHIP membership.

    <p>True</p> Signup and view all the answers

    The Return Service Agreement requires government-funded scholars to render at least five years of service.

    <p>False</p> Signup and view all the answers

    The Scholarship and Training Program aims to reorient health professional education, certification, and regulation for provision of specialized care services.

    <p>False</p> Signup and view all the answers

    PhilHealth recognizes a second-party accreditation mechanism.

    <p>False</p> Signup and view all the answers

    The rating system in PhilHealth is established by the DOH.

    <p>False</p> Signup and view all the answers

    At least 80% of government hospitals are required to have basic accommodation.

    <p>False</p> Signup and view all the answers

    The Independent Price Negotiation Board negotiates prices on behalf of the LGUs.

    <p>False</p> Signup and view all the answers

    The Health Promotion Bureau is established under the DOH.

    <p>True</p> Signup and view all the answers

    The Health Technology Assessment (HTA) process is institutionalized within the DOST.

    <p>False</p> Signup and view all the answers

    The Health Information System is developed and funded by the LGUs.

    <p>False</p> Signup and view all the answers

    The Public Health Ethics Committee is an advisory body to the Secretary of Education.

    <p>False</p> Signup and view all the answers

    Population-based health services provided by the DOH include disease surveillance and epidemiology systems.

    <p>True</p> Signup and view all the answers

    PhilHealth will be contracting public-private healthcare provider networks that agree on co-payment mechanisms only.

    <p>False</p> Signup and view all the answers

    Universal Health Coverage seeks to ensure that everyone obtains the health care they need without financial hardship.

    <p>True</p> Signup and view all the answers

    Apex or end-repair hospitals are not considered as stand-alone healthcare providers.

    <p>False</p> Signup and view all the answers

    The three dimensions of improving Universal Health Coverage are population, service, and quality coverage.

    <p>False</p> Signup and view all the answers

    PhilHealth is required to outsource certain functions to ensure operational efficiency and fulfillment of the Act in the first 5 years.

    <p>False</p> Signup and view all the answers

    The Universal Health Care Act mandates the government to institutionalize healthcare provider networks composed of public health facilities only.

    <p>False</p> Signup and view all the answers

    Primary care is not a prerequisite for accessing higher levels of care under the Universal Healthcare Act.

    <p>False</p> Signup and view all the answers

    The creation of a Joint Congressional Oversight Committee on UHC is an oversight provision.

    <p>True</p> Signup and view all the answers

    Province-wide and city-wide health systems are not mandated to pool and manage all financial resources in their respective special health funds.

    <p>False</p> Signup and view all the answers

    Total incremental sin tax collections are not a source of funding for Universal Health Coverage.

    <p>False</p> Signup and view all the answers

    Managerial integration of province-wide and city-wide systems is expected to be achieved within the first 5 years.

    <p>False</p> Signup and view all the answers

    The National Human Resource for Health Master Plan is to provide policies and strategies for health workforce based on population needs.

    <p>True</p> Signup and view all the answers

    PhilHealth is not shifting towards paying providers using performance-driven, close-end, prospective payments.

    <p>False</p> Signup and view all the answers

    The Performance Monitoring Division is not responsible for monitoring and evaluating the implementation of Universal Health Coverage.

    <p>False</p> Signup and view all the answers

    The integration of all local health systems is expected to be achieved through a legislative act.

    <p>False</p> Signup and view all the answers

    Provincial or city health boards do not oversee and coordinate the integration and delivery of health services across the healthcare continuum.

    <p>False</p> Signup and view all the answers

    The National Government subsidy to PhilHealth is not a source of funding for Universal Health Coverage.

    <p>False</p> Signup and view all the answers

    Municipalities and cities are not entitled to representations to local health boards if they commit to integrate their health system.

    <p>False</p> Signup and view all the answers

    Quality of care is not a dimension of Universal Health Coverage.

    <p>False</p> Signup and view all the answers

    Expanding primary care health packages is a way to enhance the quality of primary care services.

    <p>False</p> Signup and view all the answers

    Establishing linkages to apex hospitals is a way to strengthen care coordination and referral mechanisms.

    <p>True</p> Signup and view all the answers

    Registering citizens to a primary care provider is a way to improve health literacy.

    <p>False</p> Signup and view all the answers

    Individual-based health services are non-rival.

    <p>False</p> Signup and view all the answers

    Population-based health services have external effects.

    <p>True</p> Signup and view all the answers

    Licensing primary care facilities is a way to expand the availability and accessibility of primary care services.

    <p>False</p> Signup and view all the answers

    Providing ambulances and patient transport services is a way to strengthen care coordination and referral mechanisms.

    <p>True</p> Signup and view all the answers

    Identifying GIDAs is a way to strengthen health services in geographically isolated and disadvantaged areas.

    <p>True</p> Signup and view all the answers

    Improving health literacy is a way to strengthen care coordination and referral mechanisms.

    <p>False</p> Signup and view all the answers

    Population-based health services are excludable.

    <p>False</p> Signup and view all the answers

    Every Filipino citizen is automatically included in the National Health Insurance Program under the UHC Act.

    <p>True</p> Signup and view all the answers

    The primary objective of the Universal Health Care Act is to reduce healthcare costs.

    <p>False</p> Signup and view all the answers

    A Health Care Provider Network is a group of only private healthcare providers.

    <p>False</p> Signup and view all the answers

    Primary care providers act as navigators and coordinators of healthcare within the Health Care Provider Network.

    <p>True</p> Signup and view all the answers

    The Provincial or City Health Board oversees the integration and delivery of health services.

    <p>True</p> Signup and view all the answers

    Primary Health Care is not a guiding philosophy and approach in the Universal Health Care Act.

    <p>False</p> Signup and view all the answers

    Improving health services financed by taxation can advance Universal Health Coverage.

    <p>True</p> Signup and view all the answers

    The purpose of the Special Health Fund is to allocate funds for health research and development.

    <p>False</p> Signup and view all the answers

    The UHC Act aims to reduce the out-of-pocket expenditure of individuals for healthcare services.

    <p>True</p> Signup and view all the answers

    Providing health insurance to people without health services being available is an example of 'pseudo coverage'.

    <p>True</p> Signup and view all the answers

    Health services that have population groups as recipients are considered individual-based health services.

    <p>False</p> Signup and view all the answers

    PhilHealth is a primary financier of population-based health services.

    <p>False</p> Signup and view all the answers

    Disaster risk reduction and management in health is an example of individual-based health services.

    <p>False</p> Signup and view all the answers

    The national government share from PAGCOR is a source of funding for UHC.

    <p>True</p> Signup and view all the answers

    The LGU Health Scorecard is used to assess the performance of individual-based health services.

    <p>False</p> Signup and view all the answers

    Out-patient benefit packages are an example of population-based health services.

    <p>False</p> Signup and view all the answers

    The special health fund is used to finance individual-based health services.

    <p>False</p> Signup and view all the answers

    The rating system is used to assess the performance of health facilities in the local health system.

    <p>True</p> Signup and view all the answers

    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)
    • 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)
    • 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

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    Description

    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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