All you need to know about RA 11223 or the Universal Health Care Act.
On February 2019, President Rodrigo Duterte signed the Universal Health Care Bill into law, ushering in massive reforms in the Philippine health sector. Among the salient features of the UHC Law are the expansion of population, service, and financial coverage through an array of health system amendments.
Along with this is a planned paradigm shift to primary care, which is the core and center of all health reforms under the UHC.
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What is Universal Health Care
With UHC (Universal Health Care Act), all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk. The UHC helps ensure every Filipino is healthy, protected from health hazards and risks, and has access to affordable, quality, and readily available health service that is suitable to their needs.
To see all details of the Universal Health Care Act, you can Download this PDF.
Who will benefit from the UHC Act?
All Filipinos will benefit from the UHC Act. The government will ensure that the wellbeing and health needs of all Filipinos, especially those of the vulnerable population, will be addressed.
How will the UHC Act ensure that every Filipino has access to quality and affordable health care?
Every Filipino should be able to access preventive, promotive, curative, rehabilitative, and palliative health services. The UHC Act will improve and strengthen existing health sector processes and systems by highlighting primary care close to families and communities, supported by hospitals that are contracted as part of a network, and making PhilHealth membership automatic for every Filipino. This will eventually lead to the establishment of better networks of providers and facilities, making health accessible for all.
Will all health services be free through UHC?
One of the goals of the UHC Act is to decrease the out-of-pocket expenses of families. This means that some health services may become more affordable, but not everything will be free. At the very least, the prices of health goods and services will be predictable and affordable.
Depending on the available budget, such as additional revenue from tobacco, alcohol, and sugar-sweetened beverage taxes, and the value-based decisions of health technology assessment, DOH and PhilHealth will design benefits for this.
What do you mean by a primary care-focused health system?
In a primary care-focused health system, the frontline of health services will be strengthened so that every Filipino will have a trusted primary care provider. The primary care provider will be the initial and continuing point-of-contact of patients/clients with the health system.
He/She will provide the needed basic health services. If higher-level health services are needed, the primary care provider will navigate patients/clients to a health care provider that can give the appropriate care. By providing clinical leadership and guidance, hospitals may influence the design of these primary care services while allowing them to focus on more complicated cases.
When will the UHC Act be operationalized?
The IRR is expected to be approved by September 2019. Initially, there are 33 advanced implementation sites preparing for the roll-out of UHC in 2020, to be followed by two more batches of implementation sites to cover the country in the subsequent years.
What should provinces/HUCs/ICCs that are not AI Sites do to enact the UHC Act?
LGUs that are not AI Sites may take the initiative to implement the various provisions of the UHC Act as they deem necessary. Further, they are encouraged to join the succeeding batches of AI Sites in order for DOH and PHIC to provide them the appropriate support in integrating their health systems.
ATTRACTIONS TO SEE IN MANILA
Klook.comAre all Filipinos members of PhilHealth? Do families still need to register/enlist with PhilHealth?
All Filipinos are now members of PhilHealth. Families who are not yet registered/enlisted with PhilHealth will be assisted by their health care provider with the next steps.
Is the PhilHealth ID required in availing benefits?
No. A Philhealth identification card is not required to avail of any health services.
Do we need to pay contributions to PhilHealth?
Under the UHC Act, Direct Contributors are those who have the capacity to pay premiums, such as employees, self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members. They will have to pay PhilHealth contributions.
All others not mentioned above are considered as Indirect Contributors. They include indigents identified by the DSWD, beneficiaries of the Conditional Cash Transfer Program, and those identified in special groups, such as senior citizens, persons with disabilities, and Sangguniang Kabataan officers. Their monthly payment in PhilHealth are covered by the national government.
What will happen if a direct contributor fails to pay monthly premium to PhilHealth?
Under the UHC Act, Direct Contributors are those who have the capacity to pay premiums, such as employees, self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members. They will have to pay PhilHealth contributions.
A direct contributor who failed to pay premiums can still avail of PhilHealth. However, he/she will have to pay missed contributions with an interest compounded monthly.
The interest penalty for employers will not be less than 3%; the interest penalty for self-earning, professional practitioners and migrant workers will not be less than 1.5%.
Will the PhilHealth premium contribution increase?
Over the next five years, PhilHealth will gradually increase premium rates for direct contributors, while providing corresponding increase in benefits. Direct contributors will have to pay the premium according to the following rates:
Year Premium Rate Income Floor Income Ceiling
2019 2.75% P10,000.00 P50,000.00
2020 3.00% P10,000.00 P60,000.00
2021 3.50% P10,000.00 P70,000.00
2022 4.00% P10,000.00 P80,000.00
2023 4.50% P10,000.00 P90,000.00
2024 5.00% P10,000.00 P100,000.00
2025 5.00% P10,000.00 P100,000.00
To illustrate, in 2019, a direct contributor who earns less than P10,000.00 per month will pay P275.00 PhilHealth premium per month (for those who are formally employed, this will be split between the employer and employee). Those earning between P10,000.00 and P50,000.00 per month will have 2.75% of their earnings paid as PhilHealth premium per month (with similar sharing between employer and employee). Those earning above P50,000.00 per month will pay P1,375.00 premium per month (with similar sharing between employer and employee).
How do we define population-based and individual-based services?
Individual-based health services refer to services which can be accessed within a health facility or that can be definitively traced back to one (1) recipient. Population-based health services refer to interventions which have population groups as recipient, e.g. health promotion, disease surveillance and vector control.
ACTIVITIES AND TOURS IN MANILA
Why is there a need to distinguish services into population-based and individual-based?
Population-based and individual-based health services require different financing mechanisms. To avoid overlap and increase efficiency, financing roles must be clearly delineated. In addition, population-based and individual-based health services are divided in such a way that ensures accountability of assigned agencies.
How will the province-wide and city-wide health systems ensure the financing of health services?
Province-wide and city-wide health systems will pool and manage the various sources of funding for health, such as DOH assistance, PhilHealth payments, donations, etc., in a Special Health Fund (SHF). The SHF can be used to finance both population-based and individual-based health services, health system operating costs, capital investments and remuneration of additional health workers and incentives for all health workers.
Is PhilHealth a Health Maintenance Organization (HMO)?
No. PhilHealth is a social health insurance agency. It is neither a health maintenance organization nor a private health insurance firm.
What is the role of private sector financing agents in financing health services under the UHC Act?
Under the Act, private sector financing agents such as HMOs and private health insurance will offer complementary (offering benefits that cover services or diagnostic-groups that PhilHealth is unable to) or supplementary (offering benefits that pay for shares of the hospital bill that PhilHealth is unable to) benefit packages to patients.
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About DOH
The Department of Health (DOH) is the executive department of the government of the Philippines responsible for ensuring access to basic public health services by all Filipinos through the provision of quality health care, the regulation of all health services and products.
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