Universal Health Care Law

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To read this article in Filipino, see Universal Health Care Law.

Republic Act No. 10606, also known as the National Health Insurance Act of 2013 or the Universal Health Care Act, is a law that provides comprehensive health care services to all Filipinos through a socialized health insurance program. The law also provides for the prioritization of the health care needs of the underprivileged, sick, elderly, persons with disabilities (PWDs), women and children and provide free health care services to indigents. It was signed into law by President Benigno Aquino III on 19 June 2013.

The funds used for the implementation of the Universal Health Care Law came from the taxes collected under the Sin Tax Reform Act

History

Republic Act No. 7875 or the National Health Insurance Law was passed in 1995, creating the Philippine Health Insurance Corporation (Philhealth). However, only around 34 percent of Filipinos receive health benefits from Philhealth, a far cry from the 85 percent goal to achieve universal health coverage.

When Benigno Aquino III became president in 2010, universal health care was one of his priorities, even before the amendments to Republic Act No. 7875 were implemented. The Aquino administration aimed to raise the number of Philhealth beneficiaries to at least 40 percent of the population, giving priority to poor families.

General Provisions

Mandatory coverage

All citizens of the Philippines shall be covered by the National Health Insurance Program. The program shall also be compulsory in all provinces, cities and municipalities nationwide, notwithstanding the existence of LGU-based health insurance programs. Likewise, Philhealth, the Department of Health, local government units (LGUs), and other agencies including nongovernmental organizations (NGOs) and other national government agencies (NGAs) shall ensure that members in such localities shall have access to quality and cost-effective health care services.

All members of the population, whether they are members of the formal or informal economy, indigent members, sponsored members or lifetime members are eligible to avail benefits of the program.

Entitlement to Benefits

A member whose premium contributions for at least three months have been paid within six (6) months prior to the first day of availment, including those of the dependents, shall be entitled to the benefits of the Program, provided that such member can show that contributions have been made with sufficient regularity, and said member is not currently subject to legal penalties due to violations of the provisions of the law.

Benefit Package

Members and their dependents are entitled to the following minimum services, subject to the limitations specified in this Act and as may be determined by Philhealth:

Inpatient hospital care

  • room and board
  • services of health care professionals;
  • diagnostic, laboratory, and other medical examination services
  • use of surgical or medical equipment and facilities;
  • prescription drugs and biologicals
  • inpatient education packages

Outpatient care

  • services of health care professionals;
  • diagnostic, laboratory, and other medical examination services
  • personal preventive services; and
  • prescription drugs and biologicals

The law also provides for the following:

  • Emergency and transfer services
  • Other health care services determined by the Philhealth and DOH.

These services and packages shall be reviewed annually to determine their financial sustainability and relevance to health innovations, with the end in view of quality assurance, increased benefits and reduced out-of-pocket expenditure.

Coverage of Women About to Give Birth

The annual required premium for the coverage of unenrolled women who are about to give birth shall be fully borne by the national government and/or LGUs and/or legislative sponsor which shall be determined through the means testing protocol recognized by the Department of Social Welfare and Development.

References


Citation

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