Universal Health Care

OUTLINE
Universal Health Care
1. What is UHC for Juan and Juana?

2. Key components of the UHC Act

3. What is a UHC Integration Site

4. Expectations for Strategic Planning

Department of Health, Philippines

What is UHC for
Juan and Juana?

3
Department of Health, Philippines
Department of Health, Philippines
 BARANGAY
RURAL HEALTH UNIT HEALTH
STATION

DIAGNOSTICS SPECIALIST CLINICS

HOSPITAL
LABORATORIES

PHARMACIES APEX HOSPITAL

Department of Health, Philippines

Department of Health, Philippines
Department of Health, Philippines
Department of Health, Philippines
 DIAGNOSIS:

PNEUMONIA

Department of Health, Philippines

Department of Health, Philippines
Department of Health, Philippines
 LAB

Department of Health, Philippines

 50% 50%
patient PCP
SPECIALIST

Department of Health, Philippines

Department of Health, Philippines
 Key Components of the
Universal Health Care Act

16
 RA 11223: Universal Health Care Act
GENERAL OBJECTIVES

To ensure equitable access to quality and affordable health

care and protection against financial risk.

Department of Health, Philippines

 RA 11223: Universal Health Care Act
GENERAL OBJECTIVES

To progressively realize universal health care through

systemic approach and clear role delineation

Coordinated, not Know our role to

piecemeal “band-aid” play our part well

Department of Health, Philippines

 RA 11223: Universal Health Care Act
DECLARATION OF PRINCIPLES
Integrated and
Everyone is actively
Comprehensive People at the Center
participating
Approach

Ensure health literacy, healthy living,
and protection from hazards and
risks.
Whole-of-system Whole-of- People-oriented approach centered
government, Whole-of-society
on people’s needs and well-being
approach in the development of health
policies

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that EVERYONE
will be receiving OPTIMAL HEALTH SERVICES.

Every Filipino family is matched to a primary care team, who

ensures that they get the appropriate services they need in the
appropriate facility.

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that NO PATIENT
WILL BE LEFT ALONE.

Creation of health networks that will navigate the patients throughout

the process of their Health Care Needs. From BHS to Higher Health
Facilities back to the BHS.

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that PRIMARY CARE / COMMUNITY HEALTH
will be STRENGTHENED.

Primary Care Services and Community Health will be strengthened.

Prevention is always better than Cure.

Department of Health, Philippines

 What will UHC be for you?
LGUs will be provided with additional funding for Health Services.

Health Services in the LGU will be funded through a pooled fund. Health
Workers will be incentivized and compensated properly (Additional health
workers may be employed). Pooled fund will remain and be reflected as LGU
Income.
Department of Health, Philippines
 What will UHC be for you?
LOCAL CHIEF EXECUTIVES as CHAMPIONS OF HEALTH

LGUs will be empowered to lead on Public Health in their areas. Health Governance
is key to a Healthy Community. (RA 11223 did not explicitly repeal LGC)

Department of Health, Philippines

 Universal Health Care means…

✔ healthy living, schooling & ✔ primary care provider ✔ health spending is

working environments team for every family predictable, not “lahat libre”

✔ care is provided for by providers organized as

INTEGRATED NETWORKS

Department of Health, Philippines

 Universal Health Care
does not mean...

“A Cure All Reform”: Prescribed “Lahat Libre:”

reforms need to have careful Basic health services will be
execution to ensure success. FREE, but for fees beyond the
basics, every Filipino family’s health
spending will be predictable.

Department of Health, Philippines

 It means everyone wins!
Payers (private insurers, governments, or self-pay
Filipinos/Patients are health literate,
individuals) able to shape provider
practice healthy lifestyle, live in low-
behavior towards quality and efficiency
risk environments, receive effective
care without financial hardship

Health Care Workers earn decent Providers earn a positive margin for
predictable income and able to producing good outcomes at low cost
pursue career paths

Suppliers of drugs, devices, and diagnostic tests that improve outcomes and/or lower
total costs find their products incorporated into treatment protocols used and reimbursed

Department of Health, Philippines

 What is a
UHC Integration Site?

28
 Scope of the UHC Integration Sites (UIS)

Philippines
UHC Reforms for Immediate Implementation to the Whole Country

UIS
Simplifying Pooling National Regulating
Eliminating PhilHealth Funds HRH Coverage Transparent
Redundancies Membership to PhilHealth Master Plan Co-payment Pricing

SHF
Integration-specific reforms
Technical Integration
Health Health
Managerial Integration
Licensing
Setting and Health Impact Data Technology Financial Integration
Standards Registries Promotion Assessment Management Assessment

Department of Health, Philippines

 UHC Integration Sites

UHC Integration Sites (UIS) are provinces

and/or cities that will be supported and
contracted by DOH & PhilHealth to
demonstrate various approaches and
mechanisms to achieve:
TECHNICAL INTEGRATION
MANAGERIAL INTEGRATION by 2022
FINANCIAL INTEGRATION by 2025
as prescribed by the UHC Law.

Department of Health, Philippines

 UHC Integration Sites

The lessons and experience generated

from these sites will serve as basis for
the development of national policies on
the integration of local health systems to
attain Universal Health Coverage.

Department of Health, Philippines

 FOR GOVERNMENT
TECHNICAL INTEGRATION
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
Human FOR PATIENTS
Effective access
Finances MANAGERIAL INTEGRATION
Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
FINANCIAL INTEGRATION Career productivity
 Integrating Local
Health Systems Dimensions of Integration
A. Technical Integration
Encompasses the clinical and
public health functions to deliver
seamless, coordinated,
comprehensive primary health care
with intersectoral participation
Department of Health, Philippines
B. Managerial Integration
Consolidated administration and
management of public resources at
the province-wide/city-wide level:
Human resources for health, health
facilities and equipment, health
information system, health
technologies and medicines
C. Financial Integration
Consolidating all financial resources
within a province-wide/city-wide
health system in a Special Health
Fund, exclusively and strategically
used for health and health-related
needs.
 FOR GOVERNMENT
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
Human FOR PATIENTS
Effective access
Finances
Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
 PATIENT 1. Patients receive zero co-pay or are subject to regulated
OUTCOMES co-pay ceilings where relevant
2. Patients have access to the health personnel and
services they need in a timely manner
3. Patients have access to the medicines and devices they
need in a timely manner
4. Patients trust the HCPN in their city or province
5. Patients benefit from comprehensive, responsive and
effective public health services to the entire
province/city

Department of Health, Philippines

 FOR GOVERNMENT
Health system outcomes
EXISTING Responsiveness
PUBLIC AND Efficient resource
PRIVATE management
RESOURCES
Human FOR PATIENTS
Effective access
Finances
Trust
Facilities Quality care
Equipment Financial risk protection
Information
Standards FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
Technical Integration
1. Population catchment enumerated and needs
estimated
2. All families matched to PCP teams and PCP acts
as coordinator and navigator
3. Care coordination operational (dual referral system
- from primary to apex, then back to primary)

4. Public health functions fulfilled (disaster risk

reduction and management for health, epidemiologic
surveillance, effective and proactive health promotion)

Department of Health, Philippines

Managerial Integration
5. Unified governance and management systems
6. Sufficient, competent clinical and management staff
aligned to the network vision-mission
7. Network-wide results-based performance monitoring
and evaluation implemented
8. User-friendly health information systems informing
performance of each unit, and the network as a whole

Department of Health, Philippines

Financial Integration

9. Network-wide pooling and accounting of funds

10. Network-wide investment and resource
allocation

Department of Health, Philippines

PROVISIONAL CRITERIA
TO QUALIFY AS HCPN
 Provisional Technical/Clinical Criteria to Qualify as HCPN
Criteria Indicators Evidence
A. Population  Has a defined • Mechanism to register everyone in the catchment
Coverage population that it will • Signed, yearly individual consent form with the network per beneficiary
(Catchment) serve • Database of assigned individuals (online system)
B. Services  Has a set of defined At the minimum, the network shall have:
basic services • Empaneled facility to enlisted population ratio
developed according • At least a Level 2 hospital
to the population’s • At least a tertiary clinical lab (hospital based / stand-alone)
needs; • At least a Level 2 imaging facility (hospital-based / stand-alone)
 Has services that are • Services for Primary care/ Life stage guarantees
available within the • TB-DOTS
network are from • Newborn services: Newborn care (e.g. EINC, Hep B vaccine, BCG), NBS
primary to tertiary facility/ies, Newborn hearing screening center
care, and includes at • Prenatal care, normal, complicated, operative deliveries (including high-
the minimum: risk pregnancies)
a. Comprehensive • Blood banking
PCB • HIV screening, HIV treatment hub
b. In-patient • RPRH/FP servicese (e.g. IUD, SDI, BTL)
c. MDG benefits • Malaria
 Provisional Technical/Clinical Criteria to Qualify as HCPN
Criteria Indicators
C. Patient  Implements policies and
Navigation procedures on primary care
providers as the initial contact (i.e.
gatekeeping)
 Has provisions on navigation of
patient during emergencies and
special situations.
D. Care  Has a mechanism / system for
Coordination coordination of care (dual referral
system - from primary to apex,
then back to primary)
 Has a mechanism for care beyond
facility-based settings and
promotes continuity of care.
Evidence
• Policies and procedures on navigation and coordination/
Patient Pathway
• Demonstration of above
• Policies and procedures on navigation and coordination with
specific provisions on emergencies and special
situations/patient pathway for emergencies and special
situations
• Demonstration of above
• Policies and procedures on referral and coordination or
Patient Referral Manual adopted by the Network
• Functional Referral Module in the EMR
• Clinical pathways/patient pathways/patient navigation
instructions
• Demonstration of mechanism/system for coordinating care
• Referral mechanism to confirmatory centers and continuity
clinics (for inborn errors)
• Referral mechanism to Category B and C hearing centers for
diagnosis and treatment of hearing loss
• Policies and procedures on care beyond facility-based setting
and continuity of care/Patient Pathway
• Demonstration of mechanism/system for coordinating care
 Provisional Managerial Criteria to Qualify as an HCPN
Criteria Indicators Evidence
E. Licensing  Has DOH license and • DOH License to operate for all facilities or PhilHealth accreditation (as applicable)
and PhilHealth • Primary care certification from DOH or PhilHealth accreditation
Accreditation accreditation for all • TB DOTS certification
involved facilities (as • Certificate as newborn screening facility
applicable). • Certification/license as continuity clinic
• Certificate as Category A newborn hearing screening center OR certificate of
training of staff from DOH and NHSRC
• Certified as DOH HIV treatment hub or HIV primary care facility
• Certificate as family planning facility from DOH
• Certificate of training of professional for FP
• Certification as animal bite center from DOH
• Business permit for stand-alone peritoneal dialysis centers
• Certification from DOH as drug abuse treatment and rehabilitation center

 Has a shared • Strategic plan shows shared organizational vision and mission.
organizational
mission and vision.
• Network organizational structure
 Has a well-defined
organizational
structure.
 Provisional Managerial Criteria to Qualify as an HCPN
Criteria Indicators
F. Human  Has human resource complement that
Resource is aligned with the shared
organizational mission and vision
 Has an HR complement that meets the
defined minimum health care
professional to patient ratio.
 Has a sufficient and competent mix of
health care workers.
G. Performance  Implements polices and procedures on
Monitoring network-wide results-based
performance monitoring & evaluation.
 Has a framework for incentivizing
high-performing facilities within the
network.
Evidence
• Functioning network management team
• There is clear delineation of roles, responsibilities
and accountabilities.
• DOH License and/or PhilHealth accreditation as
applicable
• DOH License and/or PhilHealth accreditation as
applicable
• Policies and procedures on performance monitoring
• Quality assurance program
• Patient satisfaction survey
• Employee satisfaction survey
• Facility performance evaluation/scorecard
• Network evaluation/scorecard
• Policies and procedures on performance monitoring
• Network agreement regarding performance-based
incentives or disincentives
 Provisional Managerial Criteria to Qualify as an HCPN
Criteria Indicators Evidence

H. Integrated  Has an interconnected and integrated • Certificate of compliance with DOH and
information system information system among all facilities in the PhilHealth IT requirements
network that ensures that privacy and
confidentiality laws are followed

 Observes and upholds patient’s privacy and • Consent forms

confidentiality at all times during exchange of • Demonstration of IT security and
data between facilities within the network confidentiality of records
• Demonstration of medical records
sharing and exchange of information

 Maintains a detailed and efficient medical • Clinical summary form

records management • Electronic Medical Record System
• Demonstration of records management
system
• Demonstrates capacity to electronically
submit DOH and PhilHealth data
requirements
 Provisional Financial Criteria to Qualify as an HCPN
Criteria Indicators
I. Legal  Has a juridical personality allowing it
personality to receive financing from PhilHealth.
J. Fiscal  Pools funds are pooled at the
Authority network-level (network-wide
accounting) and has a mechanism of
dividing funds fairly.
 The HCPN has a network-wide
investment plan and resource
allocation supporting the HCPN’s
strategic and financial goals, and
operational targets.
 The HCPN has a menu of charges
which is implemented across the
network, which includes
professional fees.
Evidence
• Document creating the network, e.g. Sangguniang Resolution,
SEC papers
• Bank account
• Evidence of sub-ledgers
• Network agreement for the use of bank accounts and sub-
ledgers
• Policies and procedures on handling of global budget from
PhilHealth
• Investment plan for health/work and financial plan
• Network-wide investment plan and resource allocation
• Network strategic, financial and operational goals
• Aligned with Provincial Investment Plan for Health
• Policies and procedures on charging and co-payment
• Publicized menu of charges
• Demonstration of implementation of menu of charges in the
network – bills and statements of account
Organized Epidemiologic Surveillance Unit
From AO 2019-0027: Guidelines on the Implementation of the Local Government Unit Health Scorecard

1. Direction. Executive Order at the least 4. Plan and Budget: Annual Work and
(preferably Ordinance) on Financial Plan with Allotment from the
establishment of ESU local budget
2. ESU Staff composed of 5. Coordination: Link with Provincial
• Team Leader (preferably MD) Hospital and other Health Facilities
• Disease Surveillance Officer (PHN) within the locality
• Registered Medical Technologist 6. Report: Disease and Event
• Encoder Surveillance submitted in the
3. ESU Staff competent on prescribed timeline, and released at
• Basic Epidemiology Disease least on a monthly basis to the Local
Surveillance Health Board
• Event-based Surveillance

Department of Health, Philippines

Institutionalized DRRM-H System
From AO 2019-0027: Guidelines on the Implementation of the Local Government Unit Health Scorecard

1. Approved, updated, disseminated and tested Disaster Risk Reduction and Management in
Health (DRRM-H) Plans
2. Organized and trained Health Emergency Response Team on minimum required trainings: Basic
Life Support and Standard First Aid
3. Available and accessible within 24 hours essential health emergency commodities e.g.
medicines such as cotrimoxazole, amoxicillin, mefenamic acid, paracetamol, oresol, lagundi,
vitamin A and skin ointment
4. Emergency Operations Center, functional with (1) Command and Control, (2) Coordination, (3)
and Communication
Institutionalized DRRM-H Systems means availability of ALL four criteria in each Province/ City (HUC,ICC, CC)/ Municipal
Health Offices and LGU-owned hospitals. Excluded are the Barangay Health Stations and other Health Facilities (e.g.
birthing homes, animal bite treatment centers, social hygiene clinics, treatment and rehabilitation centers and the like)
LGUs are said to have institutionalized DRRM-H system when 70% - 100% of their respective Local Government Health
Facilities in their own catchment areas meet the four criteria.

Department of Health, Philippines

 FOR THE NATIONAL
GOVERNMENT
EXISTING Health system outcomes
Responsiveness
PUBLIC AND
Efficient resource
PRIVATE management
RESOURCES
Human FOR PATIENTS
Finances Effective access
Facilities Trust
Equipment Quality care
Information Financial risk protection
Standards
FOR PROVIDERS
Policies Job security
Work-life balance
Career productivity
 Capacity Building & Health Systems
Scholarships for LCEs
Health Worker
Development
Development

Information Systems Procurement

and EMR Process and Systems

DOH Intervention
Packages
Health Emergency & Health Education and
Management Services Promotion

Department of Health, Philippines

 PhilHealth Intervention Packages
New financial mechanism that will support the local health systems in
delivering accessible quality and affordable health services.

Particularly for PhilHealth:

● Demonstrate network
contracting
● Introduce global budget
● Improve primary care benefit
package (higher capitation,
disease-agnostic)

Department of Health, Philippines

 Universal Health Care is all about...

Service Coverage
- immediate eligibility
Population Coverage Financial Coverage
and access
- automatic inclusion - Zero co-payment
- comprehensive
of every Filipino citizen - Fixed, predictable
outpatient benefit
into the NHIP co-payment
- provision of primary
care provider

Department of Health, Philippines

 The Aspiration

Assurance through
Holistic and Comprehensive Coordination
Services at Point of Care Unavailable but needed
All services eligible services of the client are
to a client are given. ensured by the provider
through other providers

Department of Health, Philippines

 Committing to be a UIS means

SHF

Families are linked Health services are Facilities in a The Special Health Eligible networks
to a primary care streamlined network are linked Fund pools are financed thru a
provider to an apex hospital resources for health Global Budget

Department of Health, Philippines

 Remember that in UHC,
There is a need for
You will become Good Health =
better Resource
Health Innovators Good Politics
Management

You are the first to

=
approach Local Health Good Health Policies and Better management of
Systems Integration Management translates to resources may pave way for
nationwide. Healthier Constituents. more revenues.

Department of Health, Philippines

 Remember that in UHC,

Hard Work There is value in Multi- Services must

is essential Sectoral Cooperation focus on the Patient

The LHS Integration reform is We cannot work in “Silos” LGUs should push for accessible,
a paradigm shift. It will entail anymore. All stakeholders need comprehensive, continuous,
a lot of hard work. to contribute for UHC’s success. and coordinated care for every
individual.

Department of Health, Philippines

 Expecatations for
Strategic Planning of UIS

63
GUIDING PRINCIPLES
1. Health shall be a shared accountability among
the State, communities and individuals.
a. Taking ownership of health in the individual and community level
shall be made possible by investing in improving overall health
literacy.
b. Protection from financial risk shall be achieved thru a mechanism
to pool / share risks, such that those who can pay more are able
to support those who can pay less, that those who are well can
support those who are sick.
c. Basic health benefits shall be covered by the State while non-
basic or fringe benefits shall be shouldered by the individual.

Department of Health, Philippines

GUIDING PRINCIPLES
2. Equity and fairness shall guide the path towards
universality.
a. All Filipinos, regardless of socio-economic standing,
ethnicity, religious belief, political affiliation, source of
payment of premiums shall receive the same benefits
package under UHC.
b. Recognizing limited resources, universality shall be
progressively realized by prioritizing the needs of the
unserved, underserved, and marginalized through
evidence-based health technology assessment, and
fair and transparent priority setting.

Department of Health, Philippines

GUIDING PRINCIPLES
3. Primary health care shall be the ethos of the health
system; primary care providers shall be the bedrock of
healthcare delivery system.
a. Individual and community health and wellbeing does
NOT not depend solely on healthcare services. Multi-
sectoral action shall be fostered to address the broader
social determinants of health.
b. Investments shall be directed to shifting from a hospital-
centric, curative-focused fragmented system, towards a
people-centered, primary care-led integrated health
system.

Department of Health, Philippines

GUIDING PRINCIPLES
4. Healthcare delivery shall be patient-centric.
a. Patients shall be guaranteed access to, and
availability of, all services and commodities
deemed necessary and essential by the State.
b. Patients shall be provided necessary care
from any provider of choice.
c. In the event of any conflict of rules or
guidelines, the safety and need of the patient
shall prevail.

Department of Health, Philippines

GUIDING PRINCIPLES
5. Information shall guide decision-making at the
institutional and individual level.

a. With due respect to privacy, information on health

transactions shall be collected and processed.
Maximum disclosure of depersonalized data shall
be exercised by healthcare providers and
institutions.
b. Information and power asymmetry between
various stakeholders in health shall be minimized.

Department of Health, Philippines

GUIDING PRINCIPLES
6. There shall be equal pay for equal work; better
pay for better (more efficient, higher quality) work.
a. Licensed, accredited and contracted health service providers and suppliers
shall receive remuneration commensurate to the level of effort and quality of
service they provide, regardless of ownership or affiliation (agnostic).
b. The system shall incentivize health service providers and suppliers that add
value to the system and those which facilitate demonstrable improvements in
quality and efficiency, including embedding new technology, among others.
c. PhilHealth shall seek to cover the costs of all the services provided (improved
support value), taking into consideration all sources of financing.

Department of Health, Philippines

 Outputs of the Strategic Planning Process
Network Network Network
Vision Analysis Arrangements

Allocation of catchment areas to

potential HCPNs
Legal personality
Vision Stakeholder analysis
Management structure
Strategies Facility mapping
Decision making structure
Milestones and Timeline Service capability mapping
Facility network formation
Strategic Planning Timeline and HRH mapping
Patient flow processes
Processes Health status of population
HRH plan
Integrated investment plans
Monitoring and Evaluation

Department of Health, Philippines

 HCPN* Non-HCPN

Qualifications* Inpatient Services Global Budget Payment Case Rates Payment

- Input standards + Z benefits (status quo) + Z benefits

(service capacity) Outpatient Services Php 3,000 (per family) Php 1,500 (per family)
- Provincial Special + MDG benefits (block
payment)
+ MDG benefits (per claim)
Health Fund
- Integration across Catchments Pre-assigned (all) + transfer Pre-assigned
3** mechanism (indigent/sponsored) + choice
(others) + transfer mechanism
- Agree with
contracting terms
Provider Network-based Contracting** Accreditation
(health outcomes, Engagement
M&E, data
submissions) DOH Intervention HRH Deployment, Medicines, IT Support, Health Facility
Packages Investment Plan, Capacity Building

*All providers in the province should be part of a qualified network

**3 Aspects of Integration - managerial, technical, and financial integration

SUBJECT TO PHIC BOARD APPROVAL

Department of Health, Philippines

 Contracting by
Network Pathway of Patient Enlisted in a Network

HOSPITAL
HOSPITAL
Charge to
Charge
network
to network
(PUBLIC/PRIVATE)
(PUBLIC/PRIVATE)

SPECIALIZED
APEX
TERTIARY CARE
END REFERRAL
PRIMARY
PRIMARY
CARE CARE SPECIALIST
+ ANCILLARY
+ ANCILLARY SPECIALIST
OUTPATIENT
+ PHARMACY
+ PHARMACY OUTPATIENT
(P250 – P300)
+/- Population-based
+/- Population-based
services services

HEALTHY SICK
NON-EMERGENCY HEALTHY
SICK NON-EMERGENCY
SICK EMERGENCY

SICK EMERGENCY
Additional ENLISTED IN NETWORK
reimbursement from
PHIC using DRG
CONTRACTING
BY NETWORK Healthcare Provider Networks
• Philhealth to contract public, private or mixed
health care provider networks
• geographically-defined catchment area
• service quality
• co-payment/co-insurance
• data submission
• PhilHealth and DOH to incentivize health care
providers that form networks

Department of Health, Philippines

 Draft
Standards
Network Facility
Structure

APEX HOSPITAL

HEALTH CARE
PROVIDER
NETWORK (HCPN)
TRANSITION CARE
L1-L2 HOSPITAL FACILITIES

PRIMARY CARE
PROVIDER OUTPOSTS
NETWORK (PCPN) and
ANCILLARY
HEALTH
PROVIDERS
PRIMARY CARE (To complete
FAMILY FACILITY network service
74
(Comprehensive and Basic) capability)
 Sample Access Maps: RHU and Private

Travel time

Department of Health, Philippines

 Sample Access Maps: L3 Hospitals

Travel time

Department of Health, Philippines

 Draft
Standards Apex Hospital
To be assigned per
network by DOH based on
the Philippine Health
Within L3; Highest level comprehensive Facility Development Plan
Facility medical care in region

Within
Gatekeeping to national specialty centers, other specialty centers (including
Specialty private), with reimbursement implications
Network APEX SPECIALTY
HOSPITAL SERVICES

REFERRAL M&E

Within
Network
Oversees referral mechanism of primary Creates referral mechanism to Teaching, training, and Monitors performance of health
care facilities to apex hospital other specialty centers, research hub of region care provider networks attached
wholesale procurement,
distribution hub for networks
with CHD 77
 Draft
Standards Network Referral Mechanisms

Outpost
Comprehensive L1-L2 hospital Apex hospital
PC Facility

Ancillary Services Transition

Care Facility

78
 Draft
Standards Network Referral Components

Medical Monitoring and

M&E

Transportation Evaluation

Information and
Communication Resources
Technology Sharing and
Procurement

Referral
Mechanism Public Health
Roles
 SOURCING
RESOURCES 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 LGUs, 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

Department of Health, Philippines

D Sourcing
Resources Proposed Special Health Fund

Provincial /
LIPH
City Budget Population-based Individual-based
services services Apex Hospital

DOH Financial PhilHealth Pooled Individual-based

Grants Funds services

Appropriation Private
MOA
Ordinance Providers

Provincial / City SHF MOA

Budget for Health Non-Network

ODA, NGO, FBO Providers
Population-based services, human Financial Grants/
resources fees, and operating costs WFP, Allocation guidelines Donations

Operations and Remuneration for

Population-based
Maintenance of Health Additional Health Workers Health Systems
and Individual-based Health Research
Offices, Facilities and and Incentives for All Operating Costs
Health Services
Services Health Workers

Department of Health, Philippines

 Outputs of the Strategic Planning Process
Network Network Network
Vision Analysis Arrangements

Catchment
Vision* Management structure
Strategies* Legal personality
Stakeholder analysis*
Milestones and Timeline* Decision making structure
Facility mapping
Strategic Planning Timeline and Facility network formation
Service capability mapping
Processes* Patient flow processes
HRH mapping
HRH plan
*First activity outputs Integrated investment plans
Monitoring and Evaluation

Department of Health, Philippines