UHC Policy Agenda

As of November 8, 2019
Progressive Implementation and acknowledging constraints

Barriers to immediate implementation:

Insufficient Funds Information Asymmetry Absorptive Capacity

“Wicked Problems” Political Constraints Supply Issues

Progressive Implementation and acknowledging constraints

Main Activities:

2024 & UP Shift towards DRG-based GB, eventual phase out of ACR

2023 Prioritize HCPN & Apex hospital contracting over accreditation,

GB recalibration (normative)
Full Rollout

2022 National Nationwide contracting of HCPNs & Apex Hospitals

Simulation
2021 Shift towards a Comprehensive Primary Care Benefit, Full Pilot of HCPNs,
Benefit Expansion, Gatekeeping
Pilot
2020 Expand Primary Care benefit to all Filipinos,
Initiate shift to Global Budget, Develop contracting
rules, Revise eligibility rules, Adjust premiums
Initial Roll out
 UHC Policy Agenda
Policy Guidelines Office Target Release
Responsible of Issuance
GCG Memorandum Circular 2019-01 Selection and GCG April 2019
Nomination Process for the Appointive Directors of the
PHIC governing board in accordance with the UHC Act
CM: Premium Contribution Schedule in the NHIP PhilHealth October 2019
pursuant to RA No. 11223
DO: Guidelines on Contracting population-based DOH in consult Nov 2019
Health Services to Province-wide and City-wide Health with
Systems PhilHealth
 UHC Policy Agenda
Policy Guidelines Office Target Release
Responsible of Issuance
PhilHealth Circular: Prepayment Mechanisms for PhilHealth
Individual-based Health Services
PhilHealth Circular: PhilHealth Rules on PhilHealth
Administrative Cases of Health Care Providers,
Employers and Members December 2019
PhilHealth Circular: No Co-Payment Policy for Basic PhilHealth
or Ward Accommodation
PhilHealth Circular: Premium Contribution Schedule PhilHealth
in the NHIP
PhilHealth Circular: Premium Contributions for PhilHealth Nov-Dec 2019
Direct and Indirect Contributors
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
Corporate Order: Omnibus Guidelines on Fund Investments PhilHealth
(Revision based on UHC IRR)

PhilHealth Circulars: PhilHealth

• Service Accreditation of Primary Care Providers December
• Contracting of Health Care Provider Network 2019
• Revised Guidelines on Contracting of HCIs for the Z Benefit
Packages

PhilHealth Circular: Expansion of the Primary Care Benefit to PhilHealth

Cover all Filipinos
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Primary Care Services DOH

AO: Delineation between Population-based and Individual- DOH

based Health Services PhilHealth
Dec 2019
PhilHealth Circular: Expansion of the Primary Care Benefit to PhilHealth
Cover All Filipinos (EPCB+)
Manual: Primary Care Facility Standards DOH
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
JAO: Health Care Provider Network Contracting Standards DOH
and Process (for Individual-based Services)
Dec. 2019
Corporate Order: PhilHealth UHC Communication Plan PhilHealth

AO: Policy on Readily Accessible Price List of Offered Health HFSRB Within 2019
Services and Goods for Health Care Providers and Facilities
Include
Recommend: This must be harmonized with AO: Implementing Guidelines of PhilHealth
Health Services and Data Access System which PhilHealth will be Developing
and Linking DOH as well.
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Guidelines on Health Systems Strengthening in DOH
Geographically Isolated and Disadvantaged Areas (GIDAs)

Recommend AO: National Health Insurance Program DOH, January

Registration to Primary Care Providers PhilHEalth, 2020
DILG, DPCB,
BLHSD, HFDB
AO: Competencies of Primary Care Worker DOH
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Guidelines in Strengthening Epidemiologic Surveillance DOH
Systems PhilHealth

AO: Guidelines in Providing Primary Care Services in the DOH

Hospitals
March
2020
AO: Guidelines in Strengthening Functions of Public Health DOH
Units in Hospitals
AO: Guidelines in Determining Apex Hospitals DOH

DO: Communication Plan HPB

 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: UHC Fund Management and Monitoring System DOH in consult
with PhilHealth

AO: Guidelines on Local Health Systems Integration DOH

April 2020
Joint Circular: Guidelines on the SHF Utilization, DOH, DBM, DILG,
Allocation, Monitoring and Accountability PhilHealth

Change to AO: UHC Fund Management & Monitoring BLHSD, HPDPB,

System and PhilHealth in
coordination
Note: Fund Management also includes funds allocated with DBM, DILG
or given to LGUs
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Policy on Integrated Planning and Resource Allocation DOH in
consult with
Can this be included already in the AO: UHC Fund Management & Monitoring PhilHealth
System where integrated planning is one component of the AO

See Item 3 and 5 of Local Health System

April 2020
Features of an Integrated LHS DOH
DM or DO: Province-wide/City-wide Health Systems Normative
Maturity Curve, Integration Milestones, Process Map

If there are external entities other than DOH, must be Administrative Order PhilHealth since
data submission
AO: Implementing Guidelines on Local Health Systems Integration (recommend) and claims are
included
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
DM: Policy on Local Investment Plan for Health DOH
PhilHealth

PhilHealth Circular: Registration of Filipinos Not Yet Enrolled to Philhealth

PhilHealth Database
- Guidelines on the granting of Immediate Eligibility to
Members April 2020
- The PhilHealth Membership Form
- Revision on 90 days Single Period of Confinement
- 45 days allowable benefits
JC: Implementing Guidelines in the Use and Maintenance of KMITSD/
DOH and PhilHealth Developed Information Systems DOH
PhilHealth
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Adoption of Clinical Practice Guidelines DOH
PhilHealth
AO: Health Promotion Framework Strategy HPB

DO: Restructuring the Health Promotion and Communication HPB

Service (HPCS) into the Health Promotion Bureau (HPB)
April 2020
JAO: Implementing Guidelines for Framework Contracting of PD
Drugs and Medical Devices PhilHealth
DTI
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
GAA Supplemental Budget for UHC Implementation DOH
PhilHealth
June 2020
AO: Creation of Health Technology Assessment Council (HTAC) DOH
and Nomination Process DOST

AO: Implementing Guidelines on Price Monitoring of DOH

Drugs/Medicines, Health Goods and Services PhilHealth
July 2020
AO: Health Services and Data Access System
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: National Health Data Reporting System DOH September
Description: Implementing Guidelines and Procedures on Integrated Health Data PhilHealth 2020
Reporting

AO: Guidelines on Knowledge Management and Replication of DOH Oct 2020

Good Practices

PC: Transition Policy of Global Budget PhilHealth Dec 2020

 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
DC: Prioritization of Processing and Issuance of Applications for DOH
License to Operate and Certificate of Accreditation in GIDAs

Incentive Scheme for Contracting Facilities in GIDAs DOH in Within

consult with 2020
PhilHealth
AO: Required Allocation of Beds for Basic Accommodation HFSRB
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
PC: Primary Care Benefit Package for Health Care Provider PhilHealth
Networks (HCPNs) in UHC Implementation Sites

AO: Comprehensive Primary Care Benefit Package DOH

Dec 2021

AO: Guidelines in Estimation of Global Burden of Disease in the EB

Philippines
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
AO: Rationalization of Financing Schemes and Benefit DOH
Complementation for Individual-based Health Services with PhilHealth
PhilHealth, Health Maintenance Organizations (HMOs) and Life Insurance
and Non-Life Private Health Insurers (PHIs) Commission
PC: Prospective Payment Mechanisms Based on Diagnosis-
Related Groupings (DRGs)
Dec 2022
PC: Co-Payment and Co-Insurance Policy
PhilHealth
PC: Additional PhilHealth Benefits for Direct Contributors
PC: Supplemental Benefits

PC: Incentive Scheme based on PhilHealth Rating System

 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
PC: Standards and Requirements for Third Party Accreditation PhilHealth Dec 2022
for Quality and Safety

AO: Transitioning of Financing of Health Facilities DOH Dec 2025

PhilHealth

Updated Medium-Term Expenditure Program DOH Dec 2025

PhilHealth
 UHC Policy Agenda
Policy Guidelines Office Target
Responsible Release of
Issuance
Joint Circular: Transfer of Funds from PCSO and PAGCOR to PhilHealth
PhilHealth DBM

AO: Primary Care Policy Framework and Sectoral Strategies DOH

AO: Timeline of Transition of Individual-based Commodities DOH

PhilHealth

Recommend AO: Surveys in Support of UHC Implementation HPDPB

and Sectoral Outcomes PSA
PhilHealth