Study Set Content:
- to focus on Individual based Health Services: e.g. services that
- can be accessed within health facility (or remotely) and can be traced to one
- recipient
PhilHealth
The detailed policy program is contained in the policy document
- ‘National Objectives for Health Philippines, 2017-2022’of the Department of Health
An Act Instituting Universal Health Care for All Filipinos,
Prescribing Reforms in the Health Care System, and
Appropriating Funds Therefor
RA 11223: THE UNIVERSAL HEALTH CARE ACT
RA 11223: THE UNIVERSAL HEALTH CARE ACT
passed onto law
- February 20, 2019
RA 11223: THE UNIVERSAL HEALTH CARE ACT
Approved by
- President Rodrigo Duterte
refers to an act of a person performing a duty or function that goes beyond what is authorized by this Act and Republic Act No. 7875
Abuse of Authority
Republic Act No. 7875, otherwise known as the
"National Health Insurance Act of 1995",
Abuse of authority refers to an act of a person performing a duty or function that goes beyond what is authorized by this Act and Republic Act No. 7875, otherwise known as the "National Health Insurance Act of 1995", as amended, or their
- implementing rules and regulations (IRR), and is inimical to the public.
- refers to a percentage of a medical charge that is paid by the insured, with the rest paid by the health insurance plan.
Co-insurance
- refer to those who have the capacity to pay premiums, are gainfully employed and are bound by an employer-employee relationship, or are self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members.
Direct Contributors
- refers to a set of individual-based entitlements covered by the National Health Insurance Program (NHIP) which includes primary care; medicines, diagnostics and laboratory; and preventive, curative, and rehabilitative services.
Essential Health Benefit Package
- refers to any act of misrepresentation or deception resulting in undue benefit or advantage on the part of the doer or any means that deviate from normal procedure and is undertaken for personal gam, resulting thereafter to damage and prejudice which may be capable of pecuniary estimation.
Fraudulent Act
- refers to an entity that provides, offers, or covers designated health services for its plan holders or members for a fixed prepaid premium.
Health Maintenance Organization (HMO)
- refers to the systematic evaluation of properties, effects, or impact of health-related technologies, devices, medicines, vaccines, procedures and all other health-related systems developed to solve a health problem and improve quality of lives and health outcomes, utilizing a multidisciplinary process to evaluate the social, economic, organizational, and ethical issues of a health intervention or health technology.
Health Technology Assessment (HTA)
- refer to all others not included as direct contributors, as well as their qualified dependents, whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws.
Indirect contributors
- refers to initial-contact, accessible, continuous, comprehensive and coordinated care that is accessible at the time of need including a range of services for all presenting conditions, and the ability to coordinate referrals to other health care providers in the health care delivery system, when necessary.
Primary care
- refers to coverage of a defined set of health services financed through private payments in the form of a premium to the insurer; and
Private health insurance
Every Filipino citizen shall be automatically included into the NHIP, hereinafter referred to as the Program
Every Filipino citizen shall be automatically included into the NHIP, hereinafter referred to as the Program
Every Filipino shall be granted immediate eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental and emergency health services, delivered either as population-based or individual-based health services: Provided, That the goods and services to be included shall be determined through a fair and transparent
HTA process
How many years from the effectivity of this Act, PhilHealth shall implement a comprehensive outpatient benefit, including outpatient drug benefit and emergency medical services in accordance with the recommendations of the Health Technology Assessment Council (HTAC) created under Section 34 hereof.
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