Universal Health Care (Philippines) PDF

Universal Health Care Republic Act 11223: Universal Health Care Act - An act instituting UNIVERSAL HEALTH CARE for ALL FILIPINOS, prescribing reforms in the health care system and appropriating funds therefor - General Objectives: To ensure equitable acce...

Universal Health Care Republic Act 11223: Universal Health Care Act - An act instituting UNIVERSAL HEALTH CARE for ALL FILIPINOS, prescribing reforms in the health care system and appropriating funds therefor - General Objectives: To ensure equitable access to quality and affordable health care and protection against financial risk - To progressively realize UNIVERSAL HEALTH CARE through systemic approach and clear role delineation Declaration of Principles: Integrated and comprehensive approach to Ensure health literacy, healthy living and protection from hazards and risks Provide comprehensive health services without causing financial hardship Whole of system, whole of government, whole of society approach in the development of health policies People – oriented approach: centered on people’s needs and well being Universal Health Care means… Healthy Living, Schooling and working environments Primary care provider team for every family member Health spending is predictable, not “lahat libre” A “Systemic” Approach to UHC: 1. Financing 2. Service Delivery 3. Regulation 4. Governance Financing - Eliminating redundancies: Population – based – DOH, LGU Individual – based – PHIC - Simplifying membership into two types: Direct Contributory Indirect Contributory - Pooling of funds to PhilHealth  For all individual – based health services (e.g., Sin Tax, PAGCOR, PCSO) - Improving current provider payment mechanisms PhilHealth shall Shift to performance-driven, close-end, prospective payments based on DRGs, validated costing methods, and no differentiation between facility and professional fees Develop differential payment considering service quality Service Delivery Contracting by network and designating primary care providers as navigator Consolidating public system into province – wide and city – wide health systems Improving pool, presence, perspective of HCWs Securing resources and retaining income for health through a special health fund PhilHealth to contract public, private or mixed health care provider networks Service quality Co – payment / co – insurance Data submission PhilHealth and DOH to incentivize health care providers Province – wide 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 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 LGU’s 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  Scholarship and Training Program Expansion of existing and new health related degree and training programs Regulation of the number of enrollees based on needs Expansion of scholarship grants Reorientation of health professional education, certification and regulation towards provision of primary care services Return Service Agreement - At least three (3) years for recipients of government – funded scholarship programs National Health Workforce (NHW) Support System - Support to local public health systems in addressing human health needs, especially for GIDAs Regulation Transparent pricing of health goods and services Benefit complementation between PhilHealth and Private Health Insurance (PHIs) and Health Maintenance Organizations (HMOs) Basic and non – basic accommodation bed ratio 90:10 for government 70:30 for government specialty 10:90 for private hospitals Licensing for stand-alone health facilities, ambulatory and PCP Registry of healthcare providers Governance Allocating funding and scaling up Health Promotion initiatives Mandating Health Impact Assessment for all programs, policies and projects Mandatory use of IT systems and submission of health and financial data by health care providers and suppliers Promoting fairness and transparency in benefits expansion through Health Technology Assessment Health Promotion Transformation of HPCS to Health Promotion Bureau  At least one percent of total DOH budget earmarked for health promotion Dep ed schools to be designated as healthy settings Incorporation of health promotion in school curricula LGU to enact stricter ordinances to promote health literacy and healthy lifestyles Health Information System Health service providers and insurers to maintain a health information system to be electronically uploaded on a regular basis through interoperable system Enterprise resource planning Human resource information Electronic health records Electronic prescription pad