Universal Health Care Act

R.A. No. 11223

Frequently Asked Questions

LYNDON L. LEE SUY, MD, MPH, CESE

Assistant Secretary of Health | Health Policy and Systems Development
Team

Department of Health, Philippines

What is Universal Health Care?
Declaration of Principles and Policies (Ch. I, Sec. 2)
•Integrated and comprehensive approach to ensure health

literacy, healthy living, and protection from hazards and risks

•Health care model that provides comprehensive health

services without causing financial hardship

•Whole-of-system, whole-of-government, whole-of-

society approach in the development of health policies

•People-oriented approach centered on people’s needs and

well-being

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What do we mean by primary care-
focused health system?
Ch.I, Sec. 4(r) provides that:
“Primary care refers to initial-contact, accessible,
continuous, comprehensive and coordinated
care that is accessible at the time of need
including a range of services for all presenting
conditions, and the ability to coordinate referrals
to other health care providers in the health care
delivery system, when necessary.”

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Who is covered by the UHC Act?
Ch.II, Sec. 5. Population Coverage provides
that:

“Every Filipino citizen shall be

automatically included into the
NHIP”

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When will the UHC Act effective?
● The law is already in effect as per Sec. 46, which
provides that: “(The) Act shall take effect fifteen (15)
days after its publication in the Official Gazette or in any
newspaper of general circulation.”
● However, it cannot be implemented until an IRR
has been promulgated by the DOH and PhilHealth.
Sec. 43 provides that the IRR should be developed not
later than 180 days upon the effectivity of the Act.

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 FINANCING

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Is the PhilHealth ID required in availing
benefits?
Ch. III, Sec. 9 provides that PhilHealth
Identification Cards shall not be required in
the availment of any health services.

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Will all health services be free through
UHC?
Ch. II, Sec. 7. Financial Coverage provides that:
(a) “Population-based health services shall be financed
by the National Government through the DOH and provided
free of charge at point of service for all Filipinos.”
(b) “Individual-based health services shall be financed
primarily through prepayment mechanism such as social
health insurance, private health insurance, and HMO
plans to ensure predictability of health expenditures.”

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Will all inpatient health services be free
through UHC?
● Ch. III, Sec. 9. provides that no co-payment shall be charged
for services rendered in basic or ward accommodation.
● Ch. VII, Sec. 28(c) makes such services applicable to both public
and private hospitals subject to the requirement for hospitals to
operate bed capacity as basic or ward accommodation:
○ Government hospital ≥90%, but for Specialty hospital ≥70%
○ Private hospital ≥10%
● DOH and PhilHealth shall regulate co-payments and co-
insurance for amenities for public hospitals only.

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Do we need to pay for monthly premium?
● Sec. 4 (f) describes Direct Contributors as those who
have the capacity to pay premiums. In effect, this
group would have to pay monthly premium as provided
by the law.
● Sec. 4(o) describes Indirect Contributors as those
who are not included as direct contributors, whose
premium shall be subsidized by the national
government.

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Under UHC Act, what will happen if a
direct contributor fails to pay premium?
● Sec. 9 provides that failure to pay premiums shall not
prevent the enjoyment of benefits. However, direct
contributors (employers and self-employed) shall be
required to pay missed contributions with an interest
compounded monthly:
○ Employers = not less than 3%
○ Self earning, professional practitioners and migrant workers
= not less than 1.5%

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Will the Philhealth premium contribution
increase?
● Sec. 10 provides that direct contributors will have to
pay the premium according to the following rates:
Year Premium Rate Income Floor Income Ceiling
2019 2.75 % P10,000.00 P50,000.00
2020 3.00 % P10,000.00 P60,000.00
2021 3.50 % P10,000.00 P70,000.00
2022 4.00 % P10,000.00 P80,000.00
2023 4.50 % P10,000.00 P90,000.00
2024 5.00 % P10,000.00 P100,000.00
2025 5.00 % P10,000.00 P100,000.00

Department of Health, Philippines

Is PhilHealth an Health Maintenance
Organization (HMO)?
• The UHC Act does not amend the original charter of
PhilHealth as regards being a National Health
Insurance Program.
• The UHC Act only amended specific sections of the
PhilHealth law (i.e. composition of Board of
Directors, Reserve Funds, among others).

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What is the role of private sector in
financing health services under the UHC
Act?
• Sec. 7(b) provides that individual-based health
services shall be financed by social health
insurance, private health insurance, and HMO
plans.
• Sec. 28(e) provides that the DOH, PhilHealth, HMOs,
life and non-life private health insurance shall
develop policies and plans that complement the
NHIP’s benefit schedule.

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 SERVICE DELIVERY

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How will health promotion, preventive
services, and primary care be
prioritized?
Ch. IV, Sec. 17 provides that a province- and city-
wide health system shall be contracted for
population-based health services with the
following minimum components:
●Primary care provider network

●Epidemiologic surveillance systems

●Health promotion programs

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What does “essential health benefit
package” mean?
Ch. I, Sec. 4(i) provides that:
“Essential health benefit package refers to a
set of individual-based entitlements covered
by the National Health Insurance Program
(NHIP) which includes primary care; medicines,
diagnostic and laboratory; and preventive,
curative, and rehabilitative services.”

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 LOCAL HEALTH SYSTEM

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How will the UHC Act affect the public
health care delivery system?
The UHC Act hopes to address some of the issues that
resulted from devolution through the following:
•Ch. V, Sec. 19 provides for the reorganization of the local

health care system into province- and city-wide health

system.
•Ch. V, Sec. 20 provides for the creation of a Special Health

Fund, which will be managed by the Provincial/City

Health Board.

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How do we ensure that LGUs will finance
population-based health services?
● Ch. V, Sec. 20 provides that Special Health Fund shall finance
the population-based health services.
● Ch. V, Sec. 21 provides that all income derived from
PhilHealth shall accrue to the Special Health Fund to be
allocated exclusively for the improvement of LGU health system.
● Ch. V, Sec. 22 provides that the national government shall
provide financial and non-financial grants in accordance to
province/city-investment plans

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What is the design or model of the
service delivery network for UHC?
● Ch. 1, Sec. 4(l) defined health care provider
network as a group of primary to tertiary care
providers, whether public or private. They are
expected to offer people-centered and
comprehensive care in an integrated and
coordinated manner.

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How will public and private providers be
engaged in the service delivery network?
● Ch. 1, Sec. 4(l) defined health care provider network
as a group of primary to tertiary care providers,
whether public or private. They are expected to offer
people-centered and comprehensive care in an
integrated and coordinated manner.
● As provided in Sec. 19, health care provider network
shall be used to integrate health services for the
province- and city-wide health system.

Department of Health, Philippines

How do we comprehensively address
issues of Human Resources for Health?
Ch. VI. Human Resources for Health provides the
following mechanisms to ensure that there are enough
manpower in the different levels of the health sector:
• Sec. 23. National Health Resource Master Plan
• Sec. 24. National Health Workforce Support System
• Sec. 25. Scholarship and Training Program
• Sec. 26. Return Service Agreement

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 REGULATION

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Can specialists be accredited as primary
care practitioner?
● Ch. VI. Sec. 25(d) provides that CHED, PRC and DOH
in coordination with professional societies shall
reorient health professional education,
certification and regulation towards provision of
primary care services.
● Ch. XI, Sec. 41(i) provides that only those certified
by DOH and PRC as capable of providing primary care
will be eligible as primary care provider.

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Will there be reductions in the types of
benefits that are currently being given
by PhilHealth?
Ch. VII. Sec. 28(e) provides that DOH, PhilHealth,
HMOs and PHIs shall develop standard policies and
plans that complement the NHIP’s benefit schedule.
Coordination mechanism between PhilHealth,
PHIs and HMOs shall be set up to ensure that no
benefits shall be unnecessarily dropped.

Department of Health, Philippines

Can stand alone health facilities be
accredited under UHC Act?
Ch. VI, Sec.18 (a) provides that PhilHealth could endeavor
to contract health care provider networks. However, apex
and end-referral hospitals as defined by Act, can be
licensed as stand alone.
Ch. VII, Sec. 27 requires DOH to institute a licensing and
regulatory system for stand-alone health facilities,
including those providing ambulatory and primary
care services.

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Does the UHC Act provide maximum
price index for drugs sold to the public?
Ch. VII, Sec. 28 only applies to DOH health
facilities. Nonetheless, since the law does not
provide any provision contradicting existing
laws such as Cheaper Medicine Act, the latter
law prevails.

Department of Health, Philippines

How can the provision of health services
in GIDAs be ensured?
Ch. VII, Sec. 29 guarantees the distribution of
health services in GIDAs by the government. This
shall be done through annual updating of
underserved areas as basis for preferential
licensing of health facilities and contracting of
health services.

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 GOVERNANCE

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What does UHC Act provide in terms of
health information systems?
Ch. X, Sec.36 mandates all health service
providers and insurers to maintain a health
information systems consisting of enterprise
resource planning, human resource information,
electronic health records, and electronic prescription
log subject to pertinent provisions of Data Privacy Act
of 2012.

Department of Health, Philippines

Where will the funding for the
implementation of UHC Act come from?
Sec. 37 provides that the UHC shall be funded by the following:
• Total incremental sin tax collections
• 50% of the National Government share from PAGCOR
• 40% of the Charity Fund, net of Documentary Stamp Tax Payments and mandatory
contributions of PCSO
• Premium contributions of members
• Annual appropriations of the DOH
• National Government subsidy to PhilHealth
• Supplemental funding

Department of Health, Philippines

Maraming salamat po!