By: Quennie Grace Deocampo, JD-1 and Grace Olivar, JD-1
On February 20, 2019, President Rodrigo Duterte signed REPUBLIC ACT No. 11223, An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor. This Act shall be known as the “Universal Health Care Act”. The approval and signing of the Universal Health Care (UHC) Act into law was a milestone in Philippine history. This accomplishment will have an unprecedented benefit to all Filipinos.
It is the policy of the State to protect and promote the right to health of all Filipinos and instill health consciousness among them for which through this Act the State shall adopt:
(a) An integrated and comprehensive approach to ensure that all Filipinos are health literate, provided with healthy living conditions, and protected from hazards and risks that could affect their health;
(b) A health care model that provides all Filipinos access to a comprehensive set of quality and cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing financial hardship, and prioritizes the needs of the population who cannot afford such services;
(c) A framework that fosters a whole-of-system, whole-of-government, and whole-of-society approach in the development, implementation, monitoring, and evaluation of health policies, programs, and plans; and
(d) A people-oriented approach for the delivery of health services that are centered on people’s needs and well-being, and cognizant of the differences in culture, values, and beliefs.
Furthermore, this Act seeks to:
(a) Progressively realize universal health care in the country through a systemic approach and clear delineation of roles of key agencies and stakeholders towards better performance in the health system; and
(b) Ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk.
Implementing Universal Health Care (UHC) in the Philippines
The Universal Health Care Act is a very effective law, basis on the overview reports of a team which composes the Strategic Purchasing for Primary Health Care (SP4PHC) SP4PHC is a project that ThinkWell implemented in partnership with government agencies and local research institutions in five countries, with support from a grant from the Bill & Melinda Gates Foundation. The five SP4PHC countries – Burkina Faso, Indonesia, Kenya, the Philippines, and Uganda – like many countries around the world, are trying to figure out how best to engage and pay healthcare providers to improve access to high-quality primary health care services while containing costs.
In the Philippines, the project provides technical assistance to national and local governments to strengthen health purchasing policies and practices in support of the implementation of the Universal Health Care (UHC) Law enacted in 2019. To demonstrate applicability, incubate innovative ideas, and generate evidence, ThinkWell supports UHC Integration Sites in the provinces of Antique and Guimaras.
In their study, they have done an introductory brief that provides an overview of challenges confronting the Philippines health system and describes how the major provisions of the UHC Law are intended to respond to these challenges.
Addressing Inequity in the Health System
The Philippines is a culturally diverse archipelagic country in the South-East Asia Region with over 7,641 islands. Although the Philippines has shown significant improvements in health outcomes, it continues to deal with inequities and new challenges that threaten the health of its population. Specifically, those in the lower wealth group, with lower education attainment, or living in rural areas are still at a disadvantage for example in family planning and MNCH indicators for which that the fact that these population groups have higher infant mortality and fertility rates, and lower percentages of deliveries that occur in health facilities and are assisted by skilled health providers. Filipinos also continue to suffer a heavy financial burden from health spending.
Health is recognized as a basic human right by the 1987 Philippine Constitution, which declares that “the State shall protect and promote the right to health of the people”. Over the years, the Philippines has undertaken various health sector reforms towards achieving UHC. In 2010, this became an official priority of the health sector under the program Kalusugan Pangkalahatan, which is the Tagalog translation of UHC. These reforms culminated in the enactment of the UHC Law in February 2019.
In the study of their team, they described the major provisions of the UHC Law by illustrating health system features before its enactment and the changes instituted by it. These are the following:
First, for the Leadership and Governance. Before UHC law, regarding both national and local government, there are gaps in licensing and regulation of health facilities by DOH, particularly primary care facilities; fragmented administrative, technical, financial, and operational management of local health systems (primary to tertiary care) down to individual municipalities. While UHC Law mandates mandatory licensing and regulatory systems by DOH for all health facilities, including primary care facilities.
Second, for Financing. regarding coverage, purchase, fund source, and salaries. Before UHC law, multiple membership schemes make member management inefficient; PhilHealth purchases services from providers through piecemeal benefit packages and reimbursements; overlap in population and individual-based services funded by DOH and PhilHealth; Public sector salaries paid by national and/or local government. While UHC Law mandates guaranteed PhilHealth membership for all citizens; simplified, two-tiered membership scheme – direct (contributory) or indirect (subsidized); prospective, performance-based, global budget payments for health care provider networks (HCPNs) ; population-based services financed by DOH and LGUs; individual-based services financed by PhilHealth; however there is no change; intervening laws, civil service regulation, and political landscape restrict opportunities to move to performance-based payment of salaries.
Third, for service delivery regarding point of contact and provider. Before UHC law, first-contact care was sought at any level of care and fragmented delivery of services at various levels of care. While UHC Law mandates continuing, comprehensive, and coordinated referral system managed by a primary care provider; HCPNs organized within the province- or city-wide health systems.
Fourth, for the access to medical products regarding prioritization and procurement. Before UHC law, there is no institutionalized, objective, and transparent prioritization process; inefficient per facility procurement prone to bidding failures and ultimately stockouts. While UHC Law mandates HTA institutionalized through an HTA Council for all medical goods and centralized or pooled procurement mechanisms for drugs and medical devices to leverage economies of scale and improve negotiation leverage.
Fifth, for Health Workforce regarding training and primary care certification. Before UHC law, there is a general undergraduate training as default primary care training, but with recognized inadequacies; no required certification to practice primary care. While UHC Law mandates undergraduate and graduate training and curricula designed and realigned to focus on primary care competencies; certification based on primary care competencies is required for primary care providers.
Lastly, Health Information Systems regarding platform and data. Before UHC law, there are multiple existing health information systems with limited interoperability and unconsolidated and incomplete data that translate to poor quality and limited opportunities for analysis and utilization. While UHC Law mandates interoperable health information systems required for all health service providers and insurers and should be accessible to the public; standardized data submitted by all health facilities as a requirement in licensing and contracting.
In conclusion of their study, the Philippine UHC Law addresses the inequities faced by the country’s health system because of fragmented service delivery and inefficient financing systems. The government and its stakeholders continue to work towards a responsive health system that delivers quality care without the risk of the financial burden to its citizens. The UHC Law addresses health system challenges through the following:
 guaranteeing access to appropriate health services for all Filipinos through functional HCPNs;
 ensuring strategic and adequate financing and purchasing services;
 engaging local governments to effectively manage local health systems; and
 building capacity in terms of qualified human resources and seamless information systems.
It must be noted that the provisions presented here will still be subject to change as implementing guidelines and policies are being developed for the eventual national roll-out of the law.
What to Expect
Among the salient features of the UHC Law is the expansion of population, service, and financial coverage through an array of health system amendments. Along with this is a planned paradigm shift to primary care, which is the core and center of all health reforms under the UHC.
Universal Health Care means all Filipinos are guaranteed equitable access to quality and affordable health care goods and services and protected against financial risk. All Filipinos will benefit from the UHC Act. The government will ensure that the well-being and health needs of all Filipinos, especially those of the vulnerable population, will be addressed.
With UHC, all Filipinos are guaranteed equitable access to quality and affordable health care goods and services and protected against financial risk. The UHC helps ensure every Filipino is healthy, protected from health hazards and risks, and has access to affordable, quality, and readily available health service that is suitable to their needs.
For ensuring that every Filipino has access to quality and affordable health care, every Filipino should be able to access preventive, promotive, curative, rehabilitative, and palliative health services. The UHC Act will improve and strengthen existing health sector processes and systems by highlighting primary care close to families and communities, supported by hospitals that are contracted as part of a network, and making PhilHealth membership automatic for every Filipino. This will eventually lead to the establishment of better networks of providers and facilities, making health accessible for all.
One of the goals of the UHC Act is to decrease the expenses of Filipino families. This means that some health services may become more affordable, but not everything will be free. By means that the prices of health goods and services will be predictable and affordable.
Depending on the available budget, such as additional revenue from tobacco, alcohol, and sugar-sweetened beverage taxes, and the value-based decisions of health technology assessment, DOH and PhilHealth will design benefits for this.
In a primary care-focused health system, the frontline of health services will be strengthened so that every Filipino will have a trusted primary care provider. The primary care provider will be the initial and continuing point-of-contact of patients/clients with the health system. He/She will provide the needed basic health services. If higher-level health services are needed, the primary care provider will navigate patients/clients to a health care provider that can give the appropriate care. By providing clinical leadership and guidance, hospitals may influence the design of these primary care services while allowing them to focus on more complicated cases.