"We should learn to take care of our health so that more Filipinos and mostly those in need can access the benefits."
"We should learn to take care of our health so that more Filipinos and mostly those in need can access the benefits."
It is the dream of every Filipino to enjoy a government-subsidized healthcare program that will help him pay for his medical expenses. He hopes that his lifetime savings will not be depleted or used up to cover his medical needs. This risk is brought about by the reality that all of us, at some point in our life, will have to suffer physical deterioration brought about by years of toil and old age.
The general health condition of the population in a country determines the life expectancy at birth. Life expectancy is the measure of how long a person is expected to live. This may vary worldwide depending on factors like diet, gender, and environment. The life expectancy has also improved over the years due to the introduction of several vaccines (https://www.statista.com/statistics/274507/life-expectancy-in-industrial-and-developing-countries/).
The current life expectancy for the Philippines in 2020 is 71.28 years, which is a 0.18% increase from 2019. It has improved from the 68.73 year life expectancy 20 years ago (https://www.macrotrends.net/countries/PHL/philippines/life-expectancy). Based on the United Nations Development Program report, the life expectancy for male Filipinos is 67.1 years while it is 75.4 years for female Filipinos (https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy).
Developed countries like the United States, have life expectancies of 81.4 years for its female and 76.3 years for its male citizens. For Germany, another developed country, the life expectancy is 83.6 years for females and 78.8 years for males. Japan has a life expectancy of 87.5 years for females and 81.1 years for males, while South Korea has 85.8 years for females and 79.7 years for males (https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy).
With the primary objective of “providing all Filipinos equitable access to quality and affordable health care goods and services, and protection against financial risk,” Republic Act No. 11223 otherwise known as the “Universal Health Care Act” was signed into law on February 20, 2019. It echoed the policy of the State to protect and promote the right to health of all Filipinos and instill health consciousness among them (Section 2, RA 11223).
Every Filipino shall be granted immediate eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental, and emergency health services, delivered as population-based or individual-based health services (Section 6.1, Implementing Rules and Regulations [IRR]of RA 11223). The Department of Health (DOH) and local government units (LGUs) shall endeavor to provide a health care delivery system that shall afford every Filipino a primary care provider (Section 6.4, IRR).
The primary care provider shall act as the navigator, initial and continuing point of contact in the health care delivery system (Section 6.5, IRR). It is mandated that every Filipino shall register with a public or private primary care provider of choice with due consideration to proximity and ease of travel of those seeking care (Section 6.6, IRR).
The membership into the Program was simplified into two (2) types, direct and indirect. Both types include the following as qualified dependents: (a) legal spouse who is not an active member; (b) unmarried and unemployed legitimate, illegitimate children, and legally adopted or stepchildren below 21 years of age; (c) foster children as defined in RA 10165 (Foster Care Act of 2012); and (d) parents who are 60 years old and above who are not enrolled members (Section 8.1, IRR).
The “direct contributors” including their qualified dependents are: (a) employees with formal employment characterized by the existence of an employer-employee relationship, which include workers in the government and private sector; (b) kasambahays, as defined in RA 10361 (Domestic Workers Act); and (c) all other workers who are not covered by formal contracts or agreements or who have no employee-employer relationship and whose premium contributions are self-paid such as the self-earning individuals, and professional practitioners (Section 8.2, IRR).
Other direct contributors are: (a) Overseas Filipino Workers, as defined in RA 10022 (Migrant Workers Act) and RA 10801 (OWWA Act) such as sea-based Filipino workers or seafarers, and land-based overseas Filipino workers; (b) Filipinos living abroad; (c) Filipinos with dual citizenship; (d) lifetime members as defined in RA 10606 (National Health Insurance Act); and (e) all Filipinos aged 21 years and above who have the capacity to pay premiums (Section 8.2, IRR). The direct contributors shall register and/or update their records upon the effectivity of the IRR (Section 8.3, IRR).
On the other hand, indirect contributors, including their qualified dependents include the following: (a) indigents identified by the DSWD; (b) beneficiaries of the Pantawid Pamilyang Filipino Program/Modified Conditional Cash Transfer (4Ps/MCCT); (c) Senior citizens who are not currently covered by the Program; and (d) persons with disability (PWD), as defined in RA 10754 (An Act Expanding the Benefits and Privileges of Persons with Disability).
Also included in the list of indirect contributors are: (a) all Filipinos aged 21 years old and above without the capacity to pay premiums; (b) Sangguniang Kabataan officials, as defined in R.A. 10742 (Sangguniang Kabataan Reform Act); and (c) those previously identified at point-of-service (POS) or during registration, members previously sponsored by LGUs and those who are not yet in the PhilHealth database and are financially incapable to pay premiums (Section 8.4, IRR).
PhilHealth shall authorize the DSWD or social welfare officers of the LGUs to determine those who are financially incapable to pay premiums (Section 8.5, IRR). Every member shall be granted immediate eligibility for health benefit packages without the need of presenting the PhilHealth identification card under the Program. However, this does not preclude the necessity to present any valid identification for purposes of proving identity (Section 9.1, IRR).
Those who are not in the PhilHealth database shall be duly registered by healthcare facilities, subject to the guidelines that will be issued by PhilHealth (Section 9.1, IRR). Failure to pay premiums shall not prevent the enjoyment of any Program benefits. However, employers and self-employed direct contributors shall be required to pay all missed contributions with an interest, compounded monthly (Section 9.2, IRR).
The Program has a “No Co-payment Policy.” Under this policy, no other fees or expenses, including professional fees, shall be charged to all members admitted in any basic or ward accommodations (Section 9.4, IRR). Those who opt for basic or ward accommodations shall be provided all necessary services and complete quality care to attain the best possible health outcomes (Section 9.5, IRR).
In the absence of available beds and transfer to another facility is not feasible, members who opt for basic or ward accommodation but admitted in non-basic accommodation shall be entitled to “no co-payment” for services, professional fees, and amenities (Section 9.6, IRR) . Members who opt for admissions in non-basic or non-ward accommodations may be charged co-payments/co-insurance for services, professional fees, and amenities (Section 9.8, IRR).
There is also the “co-payment or co-insurance” principle in determining the additional services that are not included in the minimum standards of care in the management of the conditions and charges for amenities outside the basic or ward accommodation (Section 9.10, IRR). In this regard, the DOH, PhilHealth, and the health facilities are required to regularly inform all the members of the co-payment or co-insurance scheme for public or private health care providers and public or private led health care provider networks. (Section 9.11, IRR).
There are several offenses that may be committed by the employers and these are: failure or refusal to register employees; failure or refusal to deduct contributions; failure or refusal to submit reports; and failure or refusal to accurately and timely remit contributions. If found liable after notice and hearing, the employer will be meted a fine of Fifty thousand pesos (Php 50,000.00) for every violation per affected employee, or imprisonment of not less than six (6) months but not more than one (1) year, or both fine and imprisonment, at the discretion of the court (Section 38, IRR).
Any director, officer or employee of PhilHealth who appropriates and applies funds or property for personal use; or shall willingly or negligently consents to the misappropriation without objecting and promptly reporting the matter to proper authority shall be liable for misappropriation of funds. If he commits an unethical act, abuse of authority, or performs a fraudulent act, he shall be administratively liable without prejudice to his criminal liability (Section 38.19, IRR)
The funds of PhilHealth must be used exclusively for the benefit of its members and managed properly by its directors and officers knowing full well that the premium contributions are from the hard earned money of the contributing members. While the funds are made available to all, we should learn to take care of our health so that more Filipinos and mostly those in need can access the benefits.
