1

CERTIFIED BY THE
CONGRESS OF THE PHILIPPINES
SEVENTEENTH CONGRESS
Third Regular Session
PRESIDENT OF THE
PHILIPPINES FOR ITS
} IMMEDIATE ENACTMENT
ON OCTOBER 10, 2018

SENATE

S. No. 1896

(In substitution of Senate Bill Nos. 1458, 1673 and 1714

taking into consideration Senate Bill No. 60 and House Bill
No. 5784)

PREPARED AND SUBMITTED JOINTLY BY THE COMMITTEES

ON HEALTH AND DEMOGRAPHY, WAYS AND MEANS,
AND FINANCE WITH SENATORS EJERCITO, BINAY, DE
LIMA, VILLAR, ANGARA, HONTIVEROS, RECTO,
VILLANUEVA, GATCHALIAN, PACQUIAO, SOTTO III,
DRILON AND ZUBIRI AS AUTHORS THEREOF

AN ACT INSTITUTING UNIVERSAL HEALTH CARE

FOR ALL FILIPINOS, PRESCRIBING REFORMS IN
THE HEALTH CARE SYSTEM, AMENDING FOR
THE PURPOSE CERTAIN LAWS, APPROPRIATING
FUNDS THEREFOR, AND FOR OTHER PURPOSES

Be it enacted by the Senate and House of Representatives of

the Philippines in Congress assembled:

1 CHAPTER 1

2 GENERAL PROVISIONS

3 SECTION 1. Short Title. – This Act shall be known

4 as the “Universal Health Care Act”.

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1 SEC. 2. Declaration of Principles and Policies. – It is

2 the declared policy of the State to protect and promote the

3 right to health of every Filipino and instill health

4 consciousness among them. Towards this end, the State

5 shall adopt:

6 (a) An integrated and comprehensive approach to

7 ensure that every Filipino is health literate, provided

8 healthy living conditions, and protected from hazards and

9 risks that could affect their health;

10 (b) A health care model that provides every Filipino

11 access to a comprehensive set of cost-effective and quality

12 promotive, preventive, curative, rehabilitative and

13 palliative health services without causing financial

14 hardship, prioritizing the needs of the population who

15 cannot afford such services;

16 (c) A framework that fosters a whole-of-system,

17 whole-of-government, and whole-of-society approach in the

18 development, implementation, and cognizant of health

19 policies, programs and plans; and

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1 (d) A people-oriented approach for the delivery of

2 health services that is centered on people’s needs and well-

3 being, and cognizant of the differences in culture, values

4 and beliefs.

5 SEC. 3. General Objectives. – This Act seeks to:

6 (a) Progressively realize universal health care in the

7 country through a systemic approach and clear delineation

8 of roles of key agencies and stakeholders towards better

9 performance in the health system; and

10 (b) Ensure that all Filipinos are guaranteed

11 equitable access to quality and affordable health goods and

12 services, and protected against financial risk.

13 SEC. 4. Definition of Terms. – As used in this Act,

14 (a) Amenity refers to any feature of the health

15 service that provides comfort, convenience, or pleasure.

16 Basic amenities include regular meal, bed in shared

17 accommodation, fan ventilation and shared toilet/bath.

18 Additional amenities include, but not limited to, private

19 accommodation, air conditioning, telephone, television,

20 choice of meals, among others;

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1 (b) Co-insurance refers to a percentage of a medical

2 charge that is paid by the insured, with the rest paid by

3 the health insurance plan;

4 (c) Co-payment refers to a flat fee or predetermined

5 rate paid at point of service;

6 (d) Direct Contributors refer to those who have the

7 capacity to pay premiums, who may be gainfully employed

8 with an employer-employee relationship, self-earning,

9 professional practitioners, or migrant workers;

10 (e) Emergency refers to a condition or state of a

11 patient wherein based on the objective findings of a

12 prudent medical officer on duty, there is immediate danger

13 and where delay in initial support and treatment may

14 cause loss of life or permanent disability to the patient, or

15 in the case of a pregnant woman, permanent injury or loss

16 of her unborn child, or would result in a non-institutional

17 delivery;

18 (f) Entitlement refers to any singular or package of

19 health services provided to Filipinos for the purpose of

20 improving health;
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1 (g) Essential health benefit package refers to a set of

2 individual-based entitlements covered by the NHIP which

3 shall include, but not limited to, primary care; diagnostics

4 and laboratory services; prescription medicines;

5 preventive, curative, and rehabilitative services;

6 (h) Fraudulent Act refers to any act of

7 misrepresentation or deception resulting in undue benefit

8 or advantage on the part of the doer or any means which

9 deviate from normal procedure for personal gain, resulting

10 to damage and prejudice which may be capable of

11 pecuniary estimation;

12 (i) Health care provider refers to any of the

13 following:

14 (1) A health facility, which may be public or private,

15 devoted primarily to the provision of services for health

16 promotion, prevention, diagnosis, treatment, rehabilitation

17 and palliation of individuals suffering from illness, disease,

18 injury, disability, or deformity, or in need of obstetrical or

19 other medical and nursing care, and which is recognized by

20 the Department of Health (DOH);

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1 (2) A health care professional, who is a doctor of

2 medicine, nurse, midwife, dentist, or other allied

3 professional or practitioner duly licensed to practice in the

4 Philippines;

5 (3) A community-based health care organization,

6 which is an association of members of the community

7 organized for the purpose of improving the health status of

8 that community; or

9 (4) Pharmacies or drug outlets, laboratory and

10 diagnostic clinics.

11 (j) Health care provider network refers to a group of

12 primary to tertiary care providers, whether public or

13 private, offering people-centered and comprehensive care

14 in an integrated and coordinated manner with the primary

15 care provider acting as the coordinator of health care

16 within the network;

17 (k) Health Maintenance Organization (HMO) refers

18 to an entity that provides, offers, or arranges for coverage

19 of designated health services for its plan holders or

20 members for a fixed prepaid premium;

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1 (l) Health Technology Assessment (HTA) refers to

2 the systematic evaluation of properties, effects, or impact

3 of health-related technologies, devices, medicines, vaccines,

4 procedures and all other health-related systems developed

5 to solve a health problem and improve quality of lives and

6 health outcomes. It is a multidisciplinary process to

7 evaluate the social, economic, organizational and ethical

8 issues of a health intervention or health technology;

9 (m) Indirect Contributors refer to all others not

10 included as direct contributors whose premium shall be

11 subsidized by the national government including those who

12 are subsidized as a result of special laws;

13 (n) Individual-based health services refer to services

14 which can be accessed within a health facility or remotely

15 that can be definitively traced back to one (1) recipient, has

16 limited effect at a population level and does not alter the

17 underlying cause of illness, such as ambulatory and

18 inpatient care, medicines, laboratory tests and procedures,

19 among others;
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1 (o) Population-based health services refer to health

2 services that have population groups as recipients of the

3 intervention such as health promotion, disease

4 surveillance, vector control, among others;

5 (p) Primary care refers to initial-contact, accessible,

6 continuous, comprehensive and coordinated care that is

7 accessible at the time of need. It includes a range of

8 services for all presenting conditions and the ability to

9 coordinate referrals to other health care providers in the

10 service delivery network, when necessary;

11 (q) Primary care provider refers to a health care

12 worker with defined competencies who have received

13 certification in primary care as determined by the DOH or

14 any health institutions that are licensed and certified by

15 DOH; and

16 (r) Private health insurance refers to coverage of a

17 defined set of health services financed through private

18 payments in the form of a premium to the insurer.

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1 CHAPTER II

2 UNIVERSAL HEALTH CARE (UHC)

3 SEC. 5. Population Coverage. – Every Filipino citizen

4 shall be automatically included into the National Health

5 Insurance Program (NHIP) as an indirect contributor,

6 except if they qualify as a direct contributor. PhilHealth

7 shall use the civil registration data of the Philippine

8 Statistics Authority and/or data from the National ID

9 system, as applicable to regularly validate and update

10 Philippine Health Insurance Corporation (PhilHealth)

11 membership.

12 SEC. 6. Service Coverage. –

13 (a) Every Filipino shall be granted immediate

14 eligibility and access to preventive, promotive, curative,

15 rehabilitative and palliative health services, delivered

16 either as population-based or individual-based health

17 services: Provided, That, services covered, shall be

18 determined through a fair and transparent health

19 technology assessment process; and

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1 (b) The DOH and the Local Government Units

2 (LGUs) shall endeavor to provide a health care delivery

3 system that will afford every Filipino a primary care

4 provider that would act as the initial and continuing point

5 of contact in the health care delivery system: Provided,

6 That except in emergency cases and when proximity is a

7 concern, access to higher levels of care shall be coordinated

8 by the primary care provider.

9 SEC. 7. Financial Coverage. –

10 (a) Population-Based Health Services shall be

11 financed by the National Government through the DOH

12 and shall be free at point of service for all Filipinos.

13 The National Government shall support LGUs in the

14 financing of capital investments and provision of

15 population based interventions.

16 (b) Individual-Based Health Services shall be

17 financed primarily through prepayment mechanisms such

18 as social health insurance, private health insurance, and

19 HMO plans to ensure predictability of health expenditures.

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1 CHAPTER III

2 NATIONAL HEALTH INSURANCE PROGRAM

3 SEC. 8. NHIP Membership. – Membership into the

4 NHIP shall be simplified into direct contributors and

5 indirect contributors as defined in Section 4 of this Act.

6 SEC. 9. Entitlement to Benefits. – Every member shall

7 be granted immediate eligibility for health benefit package

8 under the NHIP: Provided, That PhilHealth Identification

9 Card shall not be required in the availment of any health

10 services: Provided, further, That no co-payments shall be

11 charged for services rendered in basic accommodation:

12 Provided, finally, That co-payments and co-insurance for

13 amenities shall be regulated by the DOH and PhilHealth.

14 PhilHealth shall provide additional NHIP benefits for

15 direct contributors, where applicable: Provided, That

16 failure to pay premiums shall not prevent the enjoyment of

17 any NHIP benefits.

18 Indirect contributors shall be entitled to no balance

19 billing when admitted in any basic accommodation in

20 public hospitals: Provided, That the current PhilHealth

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1 package for indirect contributory members shall not be

2 reduced.

3 SEC. 10. Premium Contributions. – For direct

4 contributors, premium rates shall be in accordance with

5 the following schedule, and salary floor and ceiling:

YEAR PREMIUM SALARY SALARY

RATE FLOOR CEILING
2021 3% P10,000.00 P40,000.00
2023 4% P10,000.00 P40,000.00
2025 5% P10,000.00 P40,000.00
6 Provided, That for indirect contributors, premium subsidy

7 shall be gradually adjusted and included annually in the

8 General Appropriations Act (GAA): Provided, further, That

9 the funds shall be automatically released to PhilHealth at

10 the start of each calendar year: Provided, even further,

11 That the DOH, in coordination with PhilHealth, may

12 request Congress to appropriate supplemental funding to

13 meet targeted milestones of this Act: Provided, finally,

14 That for every increase in the rate of contribution of direct

15 contributors and premium subsidy of indirect contributors,

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1 PhilHealth shall provide for a corresponding increase in

2 benefits.

3 SEC. 11. NHIP Reserve Funds. – PhilHealth shall set

4 aside a portion of its accumulated revenues not needed to

5 meet the cost of the current year’s expenditures as reserve

6 funds: Provided, That the total amount of reserves shall

7 not exceed a ceiling equivalent to the amount actuarially

8 estimated for two (2) years’ projected Program

9 expenditures: Provided, further, That whenever actual

10 reserves exceed the required ceiling at the end of the fiscal

11 year, the excess of the PhilHealth reserve fund shall be

12 used to increase the Program’s benefits and to decrease the

13 amount of members’ contributions.

14 Any unused portion of the reserve fund that is not

15 needed to meet the current expenditure obligations or

16 support the above mentioned programs, shall be placed in

17 investments to earn an average annual income at

18 prevailing rates of interest and shall be referred to as the

19 Investment Reserve Fund. The Investment Reserve Fund

20 shall be invested in any or all of the following:

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1 (a) In interest-bearing bonds, securities or other

2 evidences of indebtedness of the Government of the

3 Philippines: Provided, That such investment shall be at

4 least fifty percent (50%) of the Reserve Fund;

5 (b) In debt securities and corporate bonds of prime

6 or solvent corporations created or existing under the laws

7 of the Philippines: Provided, That the issuing or its

8 predecessor entity shall not have defaulted in the payment

9 of interest on any of its securities: Provided, further, That

10 the securities are issued by companies with high growth

11 opportunities and earnings potentials: Provided, finally,

12 That such investment shall not exceed thirty percent (30%)

13 of the reserve fund;

14 (c) In interest-bearing deposits and loans to or

15 securities in any domestic bank doing business in the

16 Philippines: Provided, That in the case of such deposits,

17 this shall not exceed at any time the unimpaired capital

18 and surplus or total private deposits of the depository

19 bank, whichever is smaller: Provided, further, That the

20 bank shall have been designated as a depository for this

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1 purpose by the Monetary Board of the Bangko Sentral ng

2 Pilipinas;

3 (d) In preferred stocks of any solvent corporation or

4 institution created or existing under the laws of the

5 Philippines listed in the stock exchange with proven track

6 record or profitability over the last three (3) years and

7 payment of dividends for a period of at least three (3) years

8 immediately preceding the date of investment in such

9 preferred stocks;

10 (e) In common stocks of any solvent corporation or

11 institution created or existing under the laws of the

12 Philippines listed in the stock exchange with high growth

13 opportunities and earnings potentials;

14 (f) In bonds, securities, promissory notes or other

15 evidences of indebtedness of accredited and financially

16 sound medical institutions exclusively to finance the

17 construction, improvement and maintenance of hospitals

18 and other medical facilities: Provided, That such securities

19 and instruments shall be guaranteed by the Republic of

20 the Philippines or the issuing medical institution and the

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1 issued securities are both rated triple ‘A’ by authorized

2 accredited domestic rating agencies: Provided, further,

3 That said investments shall not exceed ten percent (10%)

4 of the total reserve fund; and

5 (g) In debt instruments and other securities traded

6 in the secondary markets with the same intrinsic quality

7 as those enumerated in paragraphs (a) to (e) hereof,

8 subject to the approval of the PhilHealth Board.

9 No portion of the Reserve Fund or income thereof

10 shall accrue to the general fund of the National

11 Government or to any of its agencies or instrumentalities,

12 including government-owned or -controlled corporations.

13 As part of its investments operations, PhilHealth may

14 hire institutions with valid trust licenses as its external

15 local fund managers to manage the reserve fund, as it may

16 deem appropriate, through public bidding. The fund

17 manager shall submit annual report on investment

18 performance to PhilHealth.

19 SEC. 12. Administrative Expense. – No more than

20 seven and one half percent (7.5%) of the actual total

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1 premium collected from direct and indirect contributory

2 members during the immediately preceding year shall be

3 allotted for the administrative cost of implementing the

4 NHIP.

5 SEC. 13. PhilHealth Board of Directors. –

6 (a) The PhilHealth Board of Directors is hereby

7 reconstituted to have a maximum of thirteen (13)

8 members, consisting of the following: (1) five (5) ex officio

9 members, namely, the Secretary of Health, Secretary of

10 Social Welfare and Development, Secretary of Budget and

11 Management, Secretary of Finance, Secretary of Labor and

12 Employment; (2) three (3) expert panel members with

13 expertise in public health, management, finance, and

14 health economics; and (3) five (5) sectoral panel members,

15 representing the direct contributory group, indirect

16 contributory group, employers group, local public health

17 systems.

18 (b) The sectoral and expert panel members must be:

19 (1) Filipino citizens and of (2) good moral character. The

20 expert panel members must: (1) be of recognized probity

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1 and independence and must have distinguished themselves

2 professionally in public, civic or academic service; (2) be in

3 the active practice of their professions for at least seven (7)

4 years; and (3) not be appointed within one (1) year after

5 losing in the immediately preceding elections, whether

6 regular or special.

7 SEC. 14. President and CEO of PhilHealth. – The

8 President of the Philippines shall appoint the President

9 and CEO of PhilHealth from the non-ex officio members

10 upon the recommendation of the Board: Provided, That the

11 Board cannot recommend a President and CEO of

12 PhilHealth unless he is a Filipino citizen and must have at

13 least seven (7) years of experience in the field of public

14 health, management, finance, and health economics or a

15 combination of any of these expertise.

16 CHAPTER IV

17 HEALTH SERVICES DELIVERY

18 SEC. 15. Population-based Health Services. – The

19 DOH shall endeavor to contract province-wide and city-

20 wide health systems for the delivery of population-based

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1 health services. Province-wide and city-wide health

2 systems shall have the following minimum components:

3 (a) Primary care provider network with patient

4 records accessible throughout the health system;

5 (b) Accurate, sensitive, and timely epidemiologic

6 surveillance systems; and

7 (c) Proactive and effective health promotion

8 programs or campaigns.

9 SEC. 16. Individual-based Health Services. –

10 (a) PhilHealth shall endeavor to contract public,

11 private, or mixed health care provider networks for the

12 delivery of individual-based health services: Provided,

13 That member access to services shall not be compromised:

14 Provided, further, That these networks agree to service

15 quality, co-payment/co-insurance, and data submission

16 standards: Provided, even further, That during the

17 transition, PhilHealth and DOH shall incentivize health

18 care providers that form networks: Provided, finally, That

19 apex or end-referral hospitals, as determined by the DOH,

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1 may be contracted as stand-alone health care providers by

2 PhilHealth.

3 (b) PhilHealth shall endeavor to shift to paying

4 providers using performance-driven, close-end, prospective

5 payments based on disease or diagnosis related groupings

6 and validated costing methodologies and without

7 differentiating facility and professional fees; develop

8 differential payment schemes that give due consideration

9 to service quality, efficiency and equity; and institute

10 strong surveillance and audit mechanisms to ensure

11 networks’ compliance to contractual obligations.

12 CHAPTER X

13 ORGANIZATION OF LOCAL HEALTH SYSTEMS

14 SEC. 17. Integration of Local Health Systems into

15 Province-wide and City-wide Health System. – The DOH,

16 Department of Local and Interior Government (DILG)

17 PhilHealth and the LGUs shall endeavor to integrate

18 health systems into Province-wide and City-wide Health

19 Systems. The Provincial and City Health Boards shall

20 oversee and coordinate the integration of health services

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1 for province-wide health systems, which shall be composed

2 of municipal and component city health systems, and city-

3 wide health systems in highly urbanized and independent

4 component cities, respectively. The Provincial and City

5 Health Board shall manage the Special Health Fund

6 referred to in Section 18 of this Act and shall exercise

7 administrative and technical supervision over health

8 facilities and health human resources within their

9 respective territorial jurisdiction: Provided, That

10 municipalities and cities included in the province-wide and

11 city-wide health system shall be entitled to a

12 representative in the Provincial or City Health Board, as

13 the case may be.

14 SEC. 18. Special Health Fund. – The province-wide

15 or city-wide health system shall pool and manage, through

16 a Special Health Fund, all resources intended for health

17 services, including income generated by health facilities, to

18 finance population-based and individual-based health

19 services, health system operating costs, capital

20 investments, and remuneration of additional health

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1 workers and incentives for all health workers: Provided,

2 That the DOH, in consultation with the DBM, shall

3 develop guidelines for the use of the Special Health Fund.

4 SEC. 19. Incentives for Improving Competitiveness of

5 the Public Health Service Delivery System. - The National

6 Government shall make available commensurate financial

7 and non-financial matching grants, including, but not

8 limited to, capital outlay, human resources for health and

9 health commodities, to improve the functionality of

10 province-wide and city-wide health systems: Provided,

11 That underserved and unserved areas shall be given

12 priority in the allocation of grants: Provided, further, That

13 the grants shall be in accordance with the approved

14 province-wide and city-wide health investment plans,

15 which shall account for complementation of public and

16 private health care providers and public or private health

17 sector investments.
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1 CHAPTER V

2 HUMAN RESOURCES FOR HEALTH

3 SEC. 19. National Health Human Resource Master

4 Plan. – The DOH, together with stakeholders, shall ensure

5 the formulation and implementation of a National Health

6 Human Resource Master Plan that will provide policies

7 and strategies for the appropriate production, recruitment,

8 retraining, regulation, retention and reassessment of the

9 health workforce based on population health needs.

10 SEC. 20. To ensure continuity in the provision of

11 the health programs and services, all health professionals

12 and health care workers shall be guaranteed permanent

13 employment.

14 SEC. 21. National Health Workforce Support

15 System. – A national health workforce (NHW) support

16 system shall be created to support local public health

17 systems, in addressing their human resource needs:

18 Provided, That deployment to Geographically Isolated and

19 Disadvantage Areas (GIDAs) shall be prioritized.

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1 SEC. 22. Scholarship and Training Program. –

2 (a) The CHED, Technical Education and Skills

3 Development Authority (TESDA), Professional Regulation

4 Commission (PRC) and the DOH shall develop and plan

5 the expansion of existing and new health-related degree

6 and training programs including those for community

7 based health care workers and regulate the number of

8 enrollees in each program based on the health needs of the

9 population especially those in underserved areas.

10 (b) The CHED and DOH shall expand scholarship

11 grants for health-related undergraduate and graduate

12 programs: Provided, That scholarships shall be based on

13 the needed cadre of national and local health managers

14 and health professionals: Provided, further, That

15 scholarships for bona fide residents of unserved or

16 underserved areas or members of indigenous peoples shall

17 be given priority.

18 (c) The PRC and the DOH, in coordination with

19 duly-registered medical and allied health professional

20 societies, shall set up a registry of medical and allied

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1 health professionals, indicating among others their current

2 number of practitioners and location of practice.

3 (d) The CHED, PRC, and DOH, in coordination with

4 duly-registered medical and allied professional societies,

5 shall reorient, medical and allied medical professional

6 education, and health professional certification and

7 regulation towards producing health workers with

8 competencies in the provision of primary care services.

9 SEC. 23. Return Service Agreement. – All graduates of

10 health-related courses from state universities and colleges

11 or government-funded scholarship programs shall be

12 required to serve for at least three (3) full years, under

13 supervision and with compensation, in priority areas in the

14 public sector: Provided, further, That those who will serve

15 for additional two (2) years, shall be provided with

16 additional incentives as determined by DOH: Provided,

17 even further, That graduates of health-related courses from

18 private schools shall be similarly encouraged to serve in

19 these areas.
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1 The DOH shall coordinate with the CHED and PRC

2 for the effective implementation of this section including

3 the establishment of guidelines for non-compliance.

4 CHAPTER VI

5 REGULATION

6 SEC. 24. Safety and Quality. –

7 (a) PhilHealth shall recognize third party

8 accreditation mechanisms and may use these as basis for

9 granting incentives.

10 (b) The DOH shall institute a licensing and

11 regulatory system for stand-alone health facilities,

12 including those providing ambulatory and primary care

13 services, and other modes of health service provision.

14 (c) The DOH shall set standards for clinical care

15 through the development, appraisal, and use of clinical

16 practice guidelines in cooperation with professional

17 societies and the academia.

18 SEC. 25. Affordability. –

19 (a) DOH-owned health care providers shall procure

20 drugs and devices guided by price reference indices,

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1 following centrally negotiated prices, sell them following

2 maximum prescribed mark-ups, and submit to DOH a

3 price list of all drugs and devices procured and sold by the

4 health care provider.

5 (b) An independent price negotiation board shall be

6 constituted to negotiate prices on behalf of the DOH and

7 PhilHealth: Provided, That the negotiated price in the

8 framework contract shall be applicable for all health care

9 provider under DOH.

10 (c) Health care providers and facilities shall be

11 required to make readily accessible to the public and

12 submit to DOH and PhilHealth, all pertinent, relevant,

13 and up-to-date information regarding the prices of health

14 services, and all goods and services being offered.

15 (d) Drug outlets shall be required at all times to

16 carry the generic equivalent of all drugs in the Primary

17 Care Formulary and shall be required to provide customers

18 with a list of therapeutic equivalent and their

19 corresponding prices when fulfilling prescriptions or in any

20 transaction.
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1 (e) The DOH, PhilHealth, HMOs, life and non-life

2 private health insurance (PHIs) shall develop standard

3 policies and plans that complement the NHIP’s benefit

4 schedule: Provided, That a coordination mechanism

5 between PhilHealth, PHIs and HMOs shall be set up to

6 ensure that no benefits shall be unnecessarily dropped.

7 SEC. 26. Equity. –

8 (a) The DOH shall annually update its list of

9 underserved areas, which shall be the basis for preferential

10 licensing of health facilities and contracting of health

11 services. The DOH shall develop the framework and

12 guidelines determine the appropriate bed capacity and

13 number of health care professionals of public health

14 facilities based on need.

15 (b) The government shall guarantee that the

16 distribution of health services and benefits provided for in

17 this Act shall be equitable by prioritizing GIDAs in the

18 provision of assistance and support.

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1 CHAPTER VII

2 GOVERNANCE AND ACCOUNTABILITY

3 SEC. 27. Health Promotion. – The DOH as the overall

4 steward for health care shall strengthen national efforts in

5 providing a comprehensive and coordinated approach to

6 health development with emphasis on scaling up health

7 promotion and preventive care.

8 The DOH shall transform its existing Health

9 Promotion and Communication Service into a full-fledged

10 Bureau, to be named as the Health Promotion Bureau, to

11 improve health literacy and to mainstream health

12 promotion and protection.

13 SEC. 28. Evidence-Informed Sectoral Policy and

14 Planning for UHC. –

15 (a) All public and private, national and local health-

16 related entities shall be required to submit health and

17 health-related data to PhilHealth including, but not

18 limited to, administrative, public health, medical,

19 pharmaceutical and health financing data: Provided, That

20 PhilHealth shall furnish the DOH a copy of the said health

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1 data: Provided, further, That the DOH shall create and

2 maintain a databank which shall serve as the hub of all

3 health data.

4 (b) The DOH and Department of Science and

5 Technology shall develop a cadre of policy systems

6 researchers, technical experts and managers by providing

7 training grants in globally-benchmarked institutions:

8 Provided, That grantees shall be required to serve for at

9 least three (3) full years, under supervision and with

10 compensation, in DOH, PhilHealth and other relevant

11 government agencies: Provided, further, That those who

12 will serve for additional two (2) years, shall be provided

13 with additional incentives as determined by concerned

14 agency.

15 (c) All health, nutrition and demographic-related

16 administrative and survey data generated using public

17 funds shall be considered public records and be made

18 accessible to the public unless otherwise prohibited by

19 other law: Provided, That any person who requests a copy

20 of such public records may be required to pay the actual

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1 costs of reproduction and copying of the requested public

2 records.

3 (d) Participatory action researches on cost-effective,

4 high-impact interventions for health promotion and social

5 mobilization shall form part of the national health research

6 agenda of the Philippine National Health Research System

7 which shall also be mandated to provide adequate funding

8 support for the conduct of these researches.

9 SEC. 29. Monitoring and Evaluation. –

10 (a) The PSA shall conduct the relevant modules of

11 household surveys annually during the first ten (10) years

12 of the implementation, and thereafter follow its regular

13 schedule.

14 (b) The DOH shall publish annual provincial burden

15 of disease estimates using internationally validated

16 estimation methods and biennially using actual public and

17 private sector data from electronic records and disease

18 registries, to support LGUs in tracking progress of health

19 outcomes.
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1 SEC. 30. Health Impact Assessment (HIA). – Health

2 Impact Assessment (HIA) shall be required for policies,

3 programs, and projects that are crucial in attaining better

4 health outcomes or those that may have an impact on the

5 health sector.

6 SEC. 31. Health Technology Assessment (HTA). –

7 (a) The HTA process shall be institutionalized as a

8 fair and transparent priority setting mechanism that shall

9 be recommendatory to the DOH and PhilHealth for the

10 development of policies and programs, regulation, and

11 determination of range of entitlements, provided for under

12 this Act: Provided, That investments on any health

13 technology nor development of any benefit package by the

14 DOH and PhilHealth shall be based on the positive

15 recommendations of the HTA: Provided, further, That the

16 HTA process shall adhere to the principles of ethical

17 soundness, inclusiveness and preferential regard for the

18 underserved, evidence-based and scientific defensibility,

19 transparency and accountability, efficiency, and

20 enforceability: Provided, finally, That the HTA unit shall

 33

1 ensure that its process shall be transparent, conducted

2 with reasonable promptness, and the result of its

3 deliberations shall be made public.

4 (b) The HTA unit is mandated to review and assess

5 all existing PHIC benefit packages: Provided, however,

6 That despite having undergone the HTA process, all health

7 technology, intervention or benefit package shall still be

8 subjected to periodic review: Provided, further, That no one

9 (1) and the same intervention or benefit package should be

10 subjected to HTA process more than once in every five (5)

11 year period.

12 (c) An HTA office shall be established within the

13 DOH and shall be composed of:

14 (1) A health economist;

15 (2) An ethicist;

16 (3) A citizen’s representative;

17 (4) A sociologist or anthropologist; and

18 (5) A clinical epidemiologist or evidence-based

19 medicine expert.
 34

1 The HTA office shall (1) provide financing and/or coverage

2 recommendations on health technologies to be financed by

3 DOH and PhilHealth (2) oversee and coordinate the HTA

4 process within DOH and PhilHealth and (3) review

5 existing DOH and PHIC benefit packages.

6 (d) The DOH, in coordination with other government

7 agencies, health professional organizations, health sector

8 civil society organizations, patients’ organization, and

9 academe, shall establish guidelines and qualifications for

10 the nomination process for advisory committee members.

11 SEC. 32. Ethics in Public Health Policy and Practice.

12 – The implementation of UHC shall be strengthened by

13 commitment of all stakeholders to abide by ethical

14 principles in public health practice.

15 (a) Conflict of interest declaration and management

16 shall be routine in all policy-determining activities, and

17 applicable to all appointed decision-makers, policymakers

18 and their staff.

19 (b) All manufacturers of drugs, medical devices,

20 biological and medical supplies registered by the FDA shall

 35

1 collect and track all financial relationships with health

2 care professionals and health care providers and report

3 these to the DOH, which shall then make this list publicly

4 available.

5 (c) A public health ethics committee shall be

6 constituted as an advisory body to the Secretary of Health

7 to ensure compliance with the provision of this section.

8 SEC. 33. Health Information System. – All health

9 service providers and insurers shall maintain information

10 systems including, but not limited to, enterprise resource

11 planning, human resource information system, electronic

12 health records, and electronic prescription consistent with

13 DOH standards which shall be electronically uploaded on a

14 regular basis through interoperable systems: Provided,

15 That the said Health Information System shall be

16 developed and funded by the DOH and PhilHealth:

17 Provided, further, That Patient privacy and confidentiality

18 shall at all times be upheld, in accordance with the Data

19 Privacy Act of 2012.

 36

1 CHAPTER VIII

2 APPROPRIATIONS

3 SEC. 34. Appropriations. – The amount necessary to

4 implement this Act shall be sourced from the following:

5 (a) Incremental sin tax collections as provided for in

6 Republic Act No. 10351 otherwise known as the Sin Tax

7 Law: Provided, That the mandated earmarks as provided

8 for in Republic Act Nos. 7171 and 8240 shall be retained;

9 (b) Fifty percent (50%) of the National Government

10 share from the income of the Philippine Gaming

11 Corporation (PAGCOR) as provided for in Presidential

12 Decree No. 1869, as amended: Provided, That the funds

13 shall be automatically transferred to PhilHealth at the

14 start of each calendar year: Provided, further, That the

15 funds shall be used by PhilHealth to improve its benefit

16 packages;

17 (c) Forty Percent (40%) of the Charity Fund, net of

18 Documentary Stamp Tax Payments, and mandatory

19 contributions of the Philippine Charity and Sweepstakes

20 Office (PCSO) as provided for Republic Act No. 1169, as

 37

1 amended: Provided, That the funds shall be automatically

2 transferred to PhilHealth at the start of each calendar

3 year: Provided, further, That the funds shall be used by

4 PhilHealth to improve its benefit packages;

5 (d) Premium contributions of members;

6 (e) Annual Appropriations of the DOH included in

7 the GAA; and

8 (f) National Government subsidy to PhilHealth

9 included in the GAA.

10 The amount necessary to implement the provisions of

11 this Act shall be included in the GAA and shall be

12 appropriated under the DOH and National Government

13 subsidy to PhilHealth. In addition, the DOH, in

14 coordination with PhilHealth, may request Congress to

15 appropriate supplemental funding to meet targeted

16 milestones of this Act.

 38

1 CHAPTER VIII

2 PENAL PROVISIONS

3 SEC. 35. Penal Provisions. – Any violation of the

4 provisions of this Act, shall suffer the corresponding

5 penalties as herein provided:

6 (a) Any health care provider contracted for the

7 provision of population-based health services who violated

8 any of the provision in their respective contract shall be

9 subject to sanctions and penalties under their respective

10 contracts without prejudice to the right of the government

11 to institute any criminal or civil action before the proper

12 judicial body.

13 (b) Any contracted health care provider for the

14 provision of individual-based health services who commits

15 an unethical act, abuses the authority vested upon him or

16 her, or perform a fraudulent act shall be punished by a fine

17 of Two hundred thousand pesos (P200,000.00) for each

18 count, or suspension of contract up to three (3) months or

19 the remaining period of its contract or accreditation

20 whichever is shorter, or both, at the discretion of the

 39

1 PhilHealth taking into consideration the gravity of the

2 offense. The same shall also constitute a criminal violation

3 punishable by imprisonment for six (6) months to one (1)

4 day up to six (6) years, upon discretion of the court without

5 prejudice to criminal liability defined under the Revised

6 Penal Code. If the health care provider is a juridical

7 person, its officers and employees or other representatives

8 found to be responsible, who acted negligently or with

9 intent, or have directly or indirectly caused the commission

10 of the violation, shall be liable. Recidivists may no longer

11 be contracted as participants of the Program.

12 (c) Any member who commits any violation of this

13 Act or knowingly and deliberately cooperates or agrees,

14 whether explicitly or implicitly, to the commission of a

15 violation by a contracted health care provider or employer

16 as defined in this section, including the filing of a

17 fraudulent claim for benefits or entitlement under this Act,

18 shall be punished by a fine of Fifty thousand pesos

19 (P50,000.00) for each count or suspension from availment

20 of the benefits of the Program for not less than three (3)
 40

1 months but not more than six (6) months, or both, at the

2 discretion of the Corporation.

3 (d) Employer –

4 (1) Failure or Refusal to Register, Deduct or Remit

5 the Contributions – Any employer who deliberately or

6 through inexcusable negligence, fails or refuses to register

7 employees, regardless of their employment status,

8 accurately and timely deduct contributions from the

9 employee’s compensation or to accurately and timely remit

10 or submit the report of the same to the Corporation shall

11 be punished with a fine of Fifty thousand pesos

12 (P50,000.00) for every count of violation per affected

13 employee, or imprisonment of not less than six (6) months

14 but not more than one (1) year, or both such fine and

15 imprisonment, at the discretion of the court.

16 Any employer or any officer authorized to collect

17 contributions under this Act who, after collecting or

18 deducting the monthly contributions from the employee’s

19 compensation, fails or refuses for whatever reason to

20 accurately and timely remit the contributions to the

 41

1 Corporation within thirty (30) days from due date shall be

2 presumed prima facie, to have misappropriated the same

3 and is obligated to hold the same in trust for and in behalf

4 of the employees and the Corporation, and is immediately

5 obligated to return or remit the amount. If the employer is

6 a juridical person, its officers and employees or other

7 representatives found to be responsible, whether they

8 acted negligently or with intent, or have directly or

9 indirectly caused the commission of the violation, shall be

10 liable.

11 (2) Unlawful Deductions – Any employer or

12 officer who shall deduct directly or indirectly from the

13 compensation of the covered employees or otherwise

14 recover from them the employer’s own contribution on

15 behalf of such employees shall be punished with a fine

16 of Five thousand pesos (P5,000.00) multiplied by the

17 total number of affected employees or imprisonment of

18 not less than six (6) months but not more than one (1)

19 year, or both such fine and imprisonment, at the

20 discretion of the court. If the unlawful deduction is

 42

1 committed by an association, partnership, corporation

2 or any other institution, its managing directors or

3 partners or president or general manager, or other

4 persons responsible for the commission of the act shall

5 be liable for the penalties provided for in this Act.

6 (3) Misappropriation of Funds by Employees of

7 the Corporation – Any employee who, without prior

8 authority or contrary to the provisions of this Act or

9 its implementing rules and regulations, wrongfully

10 receives or keeps funds or property payable or

11 deliverable to the Corporation, and who shall

12 appropriate and apply such fund or property for their

13 own personal use, or shall willingly or negligently

14 consent either expressly or implicitly to the

15 misappropriation of funds or property without

16 objecting to the same and promptly reporting the

17 matter to proper authority, shall be liable for

18 misappropriation of funds under this Act and shall be

19 punished with a fine equivalent to triple the amount

 43

1 misappropriated per count and suspension for three

2 (3) months without pay.

3 (4) Other Violations – Other violations of the

4 provisions of this Act or of the rules and regulations

5 promulgated by the Corporation shall be punished with a

6 fine of not less than Five thousand pesos (P5,000.00) but

7 not more than Twenty thousand pesos (P20,000.00).

8 All other violations involving funds of PhilHealth

9 shall be governed by the applicable provisions of the

10 Revised Penal Code or other laws, taking into

11 consideration the rules on collection, remittances, and

12 investment of funds as may be promulgated by the

13 Corporation.

14 PhilHealth may enumerate circumstances that will

15 mitigate or aggravate the liability of the offender or erring

16 health care provider, member or employer.

17 Despite the cessation of operation by a health care

18 provider or termination of practice of an independent

19 health care professional while the complaint is being

 44

1 heard, the proceeding against them shall continue until the

2 resolution of the case.

3 CHAPTER X

4 MISCELLANEOUS PROVISIONS

5 SEC. 36. Oversight Provision. – There is hereby

6 created a Joint Congressional Oversight Committee on

7 Universal Health Care to conduct a regular review of the

8 implementation of this Act which shall entail a systematic

9 evaluation of the performance, impact or accomplishments

10 of this Act and the performance of the various agencies

11 involved in realizing universal health coverage,

12 particularly with respect to their roles and functions.

13 The Joint Congressional Oversight Committee shall

14 be jointly chaired by the Chairpersons of the Senate

15 Committee on Health and Demography and the House of

16 Representatives Committee on Health. It shall be

17 composed of five (5) members from the Senate and five (5)

18 members from the House of Representatives, to be

19 appointed by the Senate President and the Speaker of the

20 House of Representatives, respectively.

 45

1 The National Economic and Development Authority,

2 in coordination with the Philippine Statistics Authority,

3 National Institutes of Health, and other academic

4 institutions shall undertake studies to validate and

5 evaluate the accomplishments of this Act. These validation

6 studies, as well as an annual report, on the performance of

7 the DOH and PhilHealth shall be submitted to the

8 Congressional Oversight Committee.

9 The DOH and PhilHealth shall allocate an adequate

10 funding for the purpose of conducting these studies.

11 SEC. 37. Transitory Provision. –

12 (a) Within thirty (30) days from the effectivity of this

13 Act, the President of the Philippines shall appoint the new

14 members of the Board and the President of the

15 Corporation. The existing board of directors shall serve in

16 a hold-over capacity until a full and permanent board of

17 directors of the Corporation is constituted and functioning.

18 (b) All officers and personnel of PhilHealth, except

19 members of the Board who shall be governed by the first

20 paragraph of this section, shall be absorbed by the

 46

1 Corporation and shall continue to perform their duties and

2 responsibilities and receive their corresponding salaries

3 and benefits. The approval of this Act shall not cause any

4 demotion in rank or diminution of salary, benefits and

5 other privileges of the incumbent personnel of PhilHealth:

6 Provided, That qualified officers and personnel may

7 voluntarily elect for retirement or separation from service

8 and shall be entitled to the benefits under existing laws:

9 Provided, further, That the GCG, in coordination with

10 DOH, PhilHealth and DBM, shall conduct reorganization,

11 rationalization and personnel planning to PhilHealth in

12 accordance with existing laws geared towards the effective

13 implementation of the provisions of this Act.

14 (c) All affected officers and personnel of the PCSO

15 shall be absorbed by the agency without demotion in rank

16 or diminution of salary, benefits and other privileges:

17 Provided, That qualified officers and personnel of the

18 agency may voluntarily elect for retirement or separation

19 from service and shall be entitled to the benefits under

20 existing laws.
 47

1 (d) In the first six (6) years of the enactment of this

2 Act, the National Government shall provide technical and

3 financial support to selected LGUs that commit to

4 province-wide integration, subject to further review after

5 the lapse of six (6) years: Provided, That in the first three

6 (3) years of the enactment of this Act, the province-wide

7 and city-wide system shall exhibit managerial integration:

8 Provided, further, That within the next three (3) years

9 thereafter, the province-wide and city-wide system shall

10 exhibit financial integration: Provided, finally, upon

11 positive recommendation by an independent study

12 commissioned by the Joint Congressional Oversight

13 Committee on Universal Health Care of the over-all benefit

14 of province-wide integration and the positive

15 recommendation of the Secretary of Health, all local health

16 systems shall be integrated as prescribed by Section 17 of

17 this Act through the issuance of an Executive Order by the

18 President.

19 (e) In the first ten (10) years of the enactment of this

20 Act, the PhilHealth may outsource certain functions to

 48

1 ensure operational efficiency and towards the fulfillment of

2 this Act: Provided, That any outsourcing shall comply with

3 provisions of in Republic Act No. 9184 and its

4 Implementing Rules and Regulations.

5 (f) In the first three (3) years of the enactment of

6 this Act: PhilHealth and DOH shall provide reasonable

7 financial and licensing incentives to contracted health care

8 facilities to form health care provider networks.

9 Thereafter, these incentives shall be withdrawn and

10 providers shall be fully subject to the provisions of Section

11 17 of this Act.

12 (g) The HTA office under the DOH shall be

13 established within one (1) year from the effectivity of this

14 Act: Provided, That within two (2) years from the

15 establishment of the HTA office, the existing health benefit

16 package should have been rationalized.

17 (h) Within three (3) years from the implementation

18 of this Act, all private insurance companies and HMOs,

19 together with DOH and PhilHealth, shall have developed a

 49

1 system of co-payment that complements PhilHealth benefit

2 packages.

3 (i) Within ten (10) years after the effectivity of this

4 Act, only those who have certified by the DOH and PRC to

5 be capable of providing primary care will be eligible to be a

6 primary care provider.

7 SEC. 38. Interpretation. – All doubts in the

8 implementation and interpretation of this Act, including

9 its implementing rules and regulations, shall be resolved

10 in favor of upholding the rights and interests of every

11 Filipino to quality, accessible and affordable health care.

12 SEC. 39. Separability Clause. – If any part or

13 provision of this Act is held invalid or unconstitutional, the

14 remaining parts or provisions not affected shall remain in

15 full force and effect.

16 SEC. 40. Applicability and Repealing Clause. – The

17 provisions of Republic Act No. 7875 as amended by

18 Republic Act No. 9241 and Republic Act No. 10606,

19 otherwise known as the “National Health Insurance Act of

 50

1 2013” shall continue to have full force and effect except

2 insofar as they are inconsistent with this Act.

3 Republic Act No. 10351, Presidential Decree No.

4 1869, as amended, and Republic Act No. 1169, as amended,

5 is hereby amended with respect to the provision of Section

6 33 of this Act.

7 Nothing in this Act shall be construed to eliminate or

8 in any way diminish NHIP benefits being enjoyed at the

9 time of promulgation of this Act.

10 All other laws, decrees, executive orders and rules

11 and regulations contrary to or inconsistent with the

12 provisions of this Act are hereby repealed or amended

13 accordingly.

14 SEC. 41. Implementing Rules and Regulations. –

15 The DOH and the PhilHealth, in consultation and

16 coordination with appropriate national government

17 agencies, civil society organizations, nongovernment

18 organizations, private sector representatives, and other

19 stakeholders, shall promulgate the necessary rules and

20 regulations for the effective implementation of this Act no

 51

1 later than one hundred and eighty (180) days upon the

2 effectivity of this Act.

3 SEC. 42. Effectivity. – This Act shall take effect

4 fifteen (15) days after its publication in the Official Gazette

5 or in any newspaper of general circulation.

Approved,