Ss Repulicofthe Bhipynes Congress of the Philippines Bites lila Seventerath Congress Oye B. [Repusuic Act No. 11223] AN ACT INSTITUTH IVERSAL HEAL SCRIBING REFOR TEM, AND APPRC cake For TINC fend the Statehiving cemiton, o28 protected from azarés and ris: foul alloc tho health: () Atbealth care model that provide all Filipinos aces tw acomprehonsive wt of quaty and cost-fective,promative, rove curative, baba ar paatve health servis ‘Wiout using financial hardehip, and prioritizes the needs {the population who cannot afford such eervics; © A framework that fosters a whole-ofsystem, whole government. and shole-of-ociety approach in the Trwrlopment inslementato, moritanng. and evaluation of ee pum programs and plans; and (A yeoplearented approach fr the delivery of health eres that centered on peoples noeds and wellbeing, and opmeant ofthe deren in culture, value, and elif SC. 8. Goneral Objectives. ~ This Ac seeks to (@)Progressvely rele universal health cae in the county dough ae approach and cleat dlineaton of Scion af Key agentes and takeholders towards better performaace in the health eystem; and. (©) Basure that all iipnos are guaranteed equitable cco to quality and fforable health care goods and sevice find preccted against nancial ik, S80, 4 Definition of Terris, — Ax wed sn ths At (a) Abuse of outhority refers to an act of 9 person periocming a duty or function that goes beyond what 9 thoriaed by this At and Republic Act No. 787, therwase Known: as the "National Health Insurance Act of 19987, 08 smended or their implementing rues and regulations (RR), find is inimical tthe publi; (Amenities refer to Sostares ofthe hth service that provide comfort or convenience, such as private Soommsdation, a soaltioning, tlopone, tle Zhe 1 mal, nog, others (6) Bsic or ward accommodation rofers othe pas, of rogular mee), bod in shared soom, fan veablation, and ‘haved tllet and bath: ©) Coinsurance retors to a percentage of a medical” charge that is paid by the sneured, withthe sea paid by the health ineurance plan (© Copayment refers toa at foe or prestormined rato aid at point of service; Direct contributors refer to those who ave the ceapuaty te ay premium are gainfully employed ad ase Youn by sn snplayerenpiye mates, cr are wearing, profesional practitioners, migrant workers inclading their ‘valid dependents, and lifetime members, @ Bmergncy refers toa condition or stata ofa patient ‘wherein based on the objective ndings of a prudent medial ‘offcer on duty, there a immediate danger and where delay in initial support and treatment may cause loa of fe or ent disability to the patient, or in the cage of a Pregnant woman, permanent injury of lee of her unbora ‘hil, or # noninstitutional delivery )Enttement refers to any singular or package of health services provided to Filpinos for the purpose of improving health; ©) Prorat health benefit package rlers toa set of individual tased entitlements covered by the National Health Insurance Program (NIIP) which includes primary care; medicines, diagnostics and labratry and prevent, carve, ‘tod rehabilitative servis: 6) rodent act refers to any act of misrepesetation ‘or deception resulting in undue benefit on advantage on the ‘part of the doer or any menns that deviate from normal Procedure and is undertaken for personal gain. resulting thereafine to damage and preadce which may be caphle (8) oath care provider refers to any of the following:) A health facility, which may be vullic or private, Auroind primarily to the provision of wervices for health promotion, prevention, diagnos, treatment, rehabilitation and plain of sivas slering from ness, disease, ify, Aisabity, oF deforaity, oF in mood of obstetrical or ether ‘modical sod ursing eae A health care professional, who may be a doctor of medicine, nurse, midwiie dentist, of wher allied professional or practioner duly loosed to practice in the Philippines: (© Pharmacies or drug outlets, laboratories and Aiagnoatie cine, © Health cre provider network refers to a group of primary t tertiary cae provider, whether public or priate, ‘ering peoplecentered and comprehensive care in an Integrated and cooninated manner with the primary eare provider acing ae the navigator snd coordinator health ere ‘thin the network (om) Health Maintenance Organization (HMO) rors to a, iy that provides, oer or covers designated heath serio forte plan holders or meme fora Sed prepand premium; (0), Health Technology Assesment (TA) refers to the systematic evaluation of properter, effects, o impact of healthtelated technologies, devices, medicines, vaccines, procedures and all ether heath related eetome developed to Solve a health problem and improve quality of ives ad health uteomes, using a mulidsaplinary proces to evaluate the octal, economic, organizational, and ethical issues of ‘tbl intervention or health techno (© Indivct contributors refer to al others not incnded tutors, sows a thee yaa depends ‘whose premium shal be aubsdied Ys the matanagoveramenk ng the who are eubsidied x eso petal ©) Individual based health serices refer ta seve which can Us aocesod within bell faty or remotely that fan be defitvely traced back to one (1) recipe, has limited tffoct ata population level and doesnot alter the underlying ‘aug of illness such as ambulatory and inpatient care. Imedicias, laboratory teste and procedures, among others @ Pepultion bos holh serce reer to inerwntions such as health promotion, disease surveillance, and vector fontral, which have popultion groups ne recpints; (0) Primory care relors ‘0 initia contact, accessible, ‘ontinnons,compeehensve and crandinated- care that fe ‘aceeable at the me of need including a range of serces for al prosenting conditions, and the ability to ordinate ‘ferrals to other health care providers in the health care Aelvery system, when necessary (© Primary care provider refers to a health care worker, with ‘rtfiaion in primary care as determined by the Department ‘Health (DOM or any heath ition that i nae and (ert by the DOH; (@ Private health insurance refers to coverage of « Aefined cet of health services financed through private paymente in the form of premium to the ineurer, and (0) Unethical act refers to any eon, scheme ar ploy ‘against the NHIP, such as overiling, upasing. harboring ont patients or recruitment practice, or any act eontary to the Code of thice of the responible pesos profess or practice, of other emir, analogous ate that put or tend to Pt in depute the integrity and effective implementation of the NAIF, CHAPTER 11 UNIVERSAL HEALTH Cake (CHO) SEC 5. Population Coverage. ~ Every’ Filipino cian ‘hall te eatomatically included into the NHIP. hersinafer Gel © a the Progen