18 September 2020
The present COVID-19 pandemic brings to the forefront the need for a strong and comprehensive health care system to all Filipinos, one that adequately addresses individual and community health care needs.
Republic Act 11223, otherwise known as the Universal Health Care Act (UHC), was enacted last 20 February 2019 to provide comprehensive health care coverage to all Filipinos regardless of the amount of contribution or even the lack thereof. Correspondingly, the Department of Health (DOH) has issued the implementing rules and regulations of the UHC Act.
Every Filipino citizen shall automatically be included in the National Health Insurance Program. Various government agencies shall collaborate and aim to include all Filipinos in the program’s member database. Presenting a PhilHealth ID is no longer required when availing of any health care services under the program. If a person is not in the program’s member database, the health care facilities shall automatically register such person.
The modes of health care service delivery may be classified into two: population-based health services, and individual-based health services. The DOH and PhilHealth shall define specific health service packages for each type of health services.
Population-based health services are intended to be received by identified groups of people as a whole. These services are geared toward the promotion of general public health, safety and protection. It is also in place to address public health emergencies or disasters, such as the present COVID-19 pandemic. 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. In providing this population-based health services, DOH in coordination with local government units (LGU) shall integrate local health systems, which are health facilities operated by LGU, into province-wide and city-wide health systems. In addition, a public health unit shall be established in all hospitals to help guide Filipinos in accessing the program. Private health care providers are likewise encouraged to participate in these province-wide and city-wide health systems through contractual arrangements. The private health care providers shall complement the health services provided by public health facilities.
Once integrated, these province-wide and city-wide health systems shall be responsible for the creation of a primary care provider network, epidemiologic surveillance systems, health promotion programs and coordinated response to public health emergencies and disasters.
On the other hand, individual-based health services are those which cater to one recipient. Examples are ambulatory and inpatient care, medicines, laboratory tests and procedures. Financing for individual-based health services shall primarily be through funds collected from prepayment mechanisms, such PhilHealth premiums, private health insurance and HMO plans. Failure to pay PhilHealth premium, however, shall not preclude availment. All individual-based health services, including those who transitioned from population-based health services, shall be covered by PhilHealth, when admitted in any basic or ward accommodation. As such, no other fees or expenses, including professional fees, shall be charged to all members for such type of accommodation. For members who opt for admissions in non-basic or non-ward accommodations, co-payments or HMO coverage is allowed.
The UHC Act is true to its mandate. Contrary to the previous practice that a qualifying contribution is necessary before availment of any PhilHealth benefit, the UHC Act provides health care access regardless of previous membership, employment, or contribution. It aims to standardize health care services by providing minimum standards to all province-wide and city-wide health systems so that no Filipino shall be left uncared for and at a disadvantage.
For further information, please contact:
Nilo T. Divina, Managing Partner, DivinaLaw
nilo.divina@divinalaw.com
