Republic of the Philippines
HOUSE OF REPRESENTATIVES
Batasan Hills, Quezon City

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL No._208

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Introduced by
ACT Teachers Party-List Rep. FRANCE L. CASTRO,
GABRIELA Women’s Party Rep. ARLENE D. BROSAS,
and KABATAAN Party-List Rep. RAOUL DANNIEL A. MANUEL

AN ACT
PROVIDING FOR A FREE, COMPREHENSIVE, AND PROGRESSIVE,
NATIONAL PUBLIC HEALTH CARE SYSTEM

EXPLANATORY NOTE

Amid a historically ailing health system, the advent of COVID-19 pandemic
further revealed the gaping and grave weaknesses of a fragmented system, with many
people, the poor mostly, struggling to avail even the most basic of health services. Health
financing was brought to its knees by the perennial problems of corruption, especially in
the Philippine Health Insurance Corporation (PhilHealth), and the high out-of-pocket
spending. Even the funds supposedly intended for the COVID-19 pandemic were not
spared as PhilHealth officials, as revealed in the recent Congress hearings, used the health
crisis to steal billions of pesos through the “Interim Reimbursement Mechanism”
scheme’,

Filipinos still die of preventable and curable diseases,? six (6) out of ten (10)
deaths are not medically attended to by a physician, public health officer, hospital
authority or other medical personnel? and household out-of-pocket expenses accounted

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philhealth

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for 53.9% of the total health expenditure.‘ Meanwhile, those who care for the sick receive
the lowest salaries among our Southeast Asian neighbors.’ Thus, it is not surprising that
the country remains one of the top exporters of doctors and nurses globally due to low
wages, overwork, contractualization and inadequate benefits.

Meanwhile, ninety-nine (99) percent of Filipinos are not able to afford their
prescription medicines as these are expensive.®

Despite a significant number of legislations on health concerns -- from the
Medical Act of 1959 (Republic Act No. 2382), Generics Act of 1988 (RA 6675), Local
Government Code of 1991 (RA 7160), Magna Carta of Public Health Workers (RA
7305), National Health Insurance Act of 1995 (RA 7875), Philippine Nursing Act of
2002 (RA 9173), Universally Accessible Cheaper and Quality Medicines Act of 2008
(RA 9502), and the Universal Health Care Law of 2019 (RA 11223) -- the country’s
public health system is still unable to be fully responsive to the needs of the Filipino
people and health workers in particular.

The current health system remains as it was decades ago: curative,
specialist-oriented, urban-based, commercialized, doctor-centered, hospital-centric,
Western-oriented and fragmented, thus unable to respond to the needs of the Filipino
people, then and more so during this time of pandemic.

To reiterate, health is increasingly becoming out of reach for most Filipinos
despite the enactment of RA 1123 or the Universal Health Care Act. A true universal
health care must be free for all Filipinos guaranteed by the State and without the need for
a national health insurance, such as the PhilHealth, in any form. This care must also be
comprehensive covering for all stages of life and for as much illnesses as possible,
inpatient and outpatient. Most of the health expenditure remains with outpatient services
and medicines that the present system does not account for, much less for other
preventive services. Hospitals remain the focus instead of communities, the true frontline
of any disease.

Given the inequitable distribution of health workforce and services, it goes without
saying that increased development is needed in the countryside where the majority of the
population are underserved. The system of devolution has done little to address the
widening inequalities in access to health care in our population. The current 1:33,000"
ratio of physicians to the population is clearly far from the World Health Organization

“ htps:/psa.gov.ph/pnha-press-release/node/1 44466

5 htps://cnnphilippines. com/news/2020/9/4/Filipino-nurses—med-techs-lowest-paid-in-Southeast-Asia-.html
© hitps://wwwphilstar.com/headlines/2019/12/07/1974968/99-pinoys-cant-buy-expensive-meds

7 https://www.ibon.org/covid-19-and-the-philippine-healthcare-system/


prescribed ideal ratio of one physician per 1,000 population.* Together with a
specialist-oriented system, less people actually receive the holistic care they need.

Likewise, there is a longstanding lack of support to public health care facilities at
all levels from the barangay health stations to tertiary care hospitals. Of the country’s
42,046 barangays, only 23,144 have health stations. However, many of these are not
functional, with no health personnel and equipment allocated. Many municipal and city
health centers, district and general hospitals, even tertiary care centers, operate with
non-functional X-ray machines, basic laboratory equipment and supplies, emergency
rooms without lifesaving drugs and life-support equipment, forcing patients to pay for
these services in private facilities.

Increasing commercialization and privatization of health services makes essential
care even more out of reach. This reneges on the State’s responsibility to provide for the
people’s right to health as enshrined in the 1987 Constitution and the 1978 Alma Ata
Declaration of which the Philippines is a signatory. With private hospitals outnumbering
the number of public hospitals (2:1),° the State must ensure the ability of people to seek
proper consultation not only when cases are severe and requiring hospitalization. Health
services should neither be an issue of privilege nor charity, and this is ensured only by
empowering communities to provide for preventive services.

All these can be seen in countries responsive to their people’s health needs, such
as Cuba, Taiwan, South Korea, and Thailand, who have improved the responsiveness of
their health systems even before the pandemic. True enough, these are also examples of
countries that have quickly contained the virus and risen above its neighbors in its
statistics. Another factor is the health spending such nations commit to, which
increasingly correlates to better health outcomes for the people. Even beyond the
often-cited 5% prescription for health from the gross domestic product, governments
must live up to its role of being primarily responsible for the health of the people.

This Bill seeks to improve health access for the entire population, beyond merely
addressing COVID-19, as there are many more maladies affecting the people before,
during, and especially after the pandemic. Marginalized communities, from our basic
sectors, women and indigenous people, must be at the fore in ensuring health for all, not
merely for those who can pay. From government regulation to provision of services,
ensuring a sustainable health education and workforce, establishing proactive and
comprehensive health financing and leadership, we envision a health system truly
responsive and committed to the people’s right to health.

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‘A “new normal” brought about by the coronavirus discase 2019 pandemic should
entail revamping the current health care system and make it a national public health
system that will ensure free, comprehensive, progressive, and quality health services for
the people.

This Bill was first filed by Bayan Muna Representatives Carlos Isagani T. Zarate,
Ferdinand R. Gaite and Eufemia C. Cullamat, ACT Teachers Party-List Representative
France L. Castro, Gabriela Women’s Party Representative Arlene D. Brosas and
Kabataan Party-List Representative Sarah Jane I. Elago as House Bill No. 9515 in the
18th Congress.

To truly help save the lives and promote the health and safety of the Filipino
people, this time of pandemic and beyond, immediate passage of this bill is earnestly
sought.

Approved,

Rep. ARLENE D. BROSAS Rep. RAOUL DANNIEL A. MANUEL
GABRIELA Women’s Party KABATAAN Party-List


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Batasan Hills, Quezon City

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL No. 208

Introduced by
ACT Teachers Party-List Rep. FRANCE L. CASTRO,
GABRIELA Women’s Party Rep. ARLENE D. BROSAS,
and KABATAAN Party-List Rep. RAOUL DANNIEL A. MANUEL

AN ACT
PROVIDING FOR A FREE, COMPREHENSIVE, AND PROGRESSIVE,
NATIONAL PUBLIC HEALTH CARE SYSTEM

Be it enacted by the Senate and House of Representatives of the Republic of the
Philippines in Congress assembled:

CHAPTER I. GENERAL PROVISIONS

SECTION 1. Short Title. - This Act shall be known as the “Free, comprehensive, and
progressive, national public health care system” or the “Free National Public Health
System Act”.

SEC. 2. Declaration of Policy. —- The State adheres to the principle that health is a basic
human right that must be ensured to all Filipinos. It is a prime function of the State to
respect, protect, promote and fulfill the right to health of the people by adopting
appropriate legislation and policies creating the social and economic conditions for
optimum health for all citizens, including but not limited to the health care system as
enshrined in international covenants.

The State firmly commits to the provision of free, comprehensive, quality health
care services through an integrated publicly funded national health system covering all
levels from the local to provincial, regional and national levels. The State shall adopt an


integrated and comprehensive approach to health development which shall endeavor to
make essential goods, health and other social services available to all the people at
affordable cost. There shall be priority for the needs of the underprivileged sick, elderly,
disabled, women and children.

The State hereby recognizes the current critical condition of the country’s health
system resulting in inequity in access and availability of health services depriving the
vast majority of Filipinos of even the most basic care and treatment.

The State recognizes the longstanding lack of support to public health care
facilities at all levels from the barangay health stations to tertiary care hospitals.

The State further recognizes the inadequate support for health workers in both
public and private sectors and the consequent crisis in the health workforce. The State has
the primary responsibility to provide its health workers the opportunity for utmost service
delivery while ensuring their welfare, just compensation, personal safety and protection,
security and professional advancement.

The State recognizes the need to develop a national pharmaceutical industry that
will ensure the availability and access of all Filipinos to affordable essential medicines
and supplies. The country’s rich and diverse natural resources, which can supply raw
materials need to be explored and tapped for the development and local manufacture by
government or Filipino-owned companies of essential drugs, biologicals and medical
supplies and equipment. Government incentives for invention and research should be
provided to spur the local production of much-needed tools and materials for disease
management.

SEC. 3. Objectives. — This Act aims to achieve the following objectives:

a) Provide universal, free, comprehensive, quality health services through a
progressive, people-centered, integrated, national health system that is publicly
funded;

Ensure a comprehensive, holistic health care system that encompasses preventive,
promotive, curative, rehabilitative and palliative components based on scientific
and culturally acceptable methods and technology;

Reorient and reorganize all components, structures and resources into a
comprehensive integrated public health system in all levels;

Formulate and implement a comprehensive national plan for health workers’
development;

Adopt a progressive health system that ensures the full participation of the people
at every stage of development in the spirit of self-reliance and self-determination
to attain essential health care universally accessible to all citizens; and

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f) Develop self-reliance in research and health technology including medicines,
pharmaceutical products, yaccines and biologicals, diagnostic and curative
equipment, devices, supplies. and protective equipment, especially the
development of a national pharmaceutical industry.

SEC. 4. Definition of Terms. — The following terms, as used herein, shall mean:

a) Alternative medicine — any of a range of medical treatments, products and
practices that are used instead of standard orthodox medical care such as special
diet and acupuncture

b) Biopsychosocial — interdisciplinary model of health which states that interactions
between biological, psychological, and social factors determine the cause,
manifestation, and outcome of wellness and disease, thus requires understanding
how suffering, disease, and illness are affected by multiple levels of organization,
from the societal to the molecular, considering the patient’s subjective experience
as an essential contributor to accurate diagnosis, health outcomes, and humane
care
Complementary medicine — treatments, products and practices that are used along
with standard medical treatments but are not considered to be standard mainstream
Western treatment
Comprehensive health care — the government shall provide the full range of
personal health services for diagnosis, treatment follow-up of patients, “womb to
tomb” services; including primary, secondary and tertiary level services rendering
preventive, promotive, curative, rehabilitative and palliative interventions that are
integrated and coordinated with other social services like food production,
education and recreation in order to foster the complete physical, mental and
social wellness of its citizens with special attention given to the welfare of the
handicapped, the elderly, orphans and children

Contractualization — the practice of hiring workers or outsourced hiring of

employees through third party agencies typically for short term employment and

terminating them often for less than six (6) months then they are laid off or
transferred to other companies

f) Health promotion — the process of engaging and enabling individuals and
communities to increase control over and improve their health, to maintain
well-being, to choose healthy behaviors, and make changes that reduce the risk of
developing chronic diseases and other morbidities

g) Health worker — all persons who are engaged in health and health related work

which shall include but not limited to health and para-health professionals, allied

health personnel, administrative and support personnel employed in government
health facilities regardless of their employment status

Holistic health care — considers the whole person and how s/he interacts with the

environment focusing on wellness and prevention rather than on illness or specific

parts of the body providing care of the physical, mental, spiritual/intellectual and

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social needs, which affect overall health, using a variety of clinically-proven

therapies

Integrated health system — characterized as unified, coherent, streamlined and

coordinated system providing high quality and high value, inclusive of primary

care providers, specialists, hospital services and allied health providers rendering

continuity of care from inpatient hospital stay to the community and the home

j) Hospital — a place devoted primarily to the maintenance and operation of health

facilities for the diagnosis, treatment and care of individuals suffering from illness,

disease, injury or deformity or in need of obstetrical or other surgical, medical and

nursing care. It shall also be construed as any institution, building or place where

there are installed beds, cribs or bassinets for twenty-four-hour use or longer by

patients in the treatment of disease

Medically necessary — health care services, interventions, products or supplies

needed to diagnose or treat an illness, injury, condition, discase or its symptoms

and that meet accepted standards of medicine

National — refers to a public health system covering the whole country rather than

a part of it, essentially based on Congressional appropriation of general revenues

with guaranteed service rather than payment-based, aimed to transform the health

system into a social instrument to achieve equity and justice

m) Palliative care — interdisciplinary medical care aimed at optimizing quality of life
of patients and their families, facing the problems associated with life-threatening,
serious or complex illness, through the prevention and relief of suffering by
means of carly identification and impeccable assessment, treatment of pain and
other physical and psychosocial problems

n) Primary care — first level of contact between individuals and families with the

health system with focus on general care for over-all patient education and

wellness

Primary health care — the application of an approach requiring full participation of

the community and at a cost that the community and country can afford to

maintain at every stage of their development in the spirit of self-reliance and

self-determination; participation is aimed at the attainment of essential health care

based on practical, scientifically sound and socially acceptable methods and

technology made universally accessible to individuals and families in the

community

p) Primary care facility — a first contact health care facility, such as but not limited to
Barangay Health Station, Rural Health Center, City Health Center, that offers basic
services including emergency service and provision for normal deliveries. It is
subdivided into: 1) with in-patient beds (infirmary and birthing home), 2) without
beds (medical out-patient clinic, medical facility for overseas workers and
seafarers (OFW clinic), and dental clinic.

q) Privatization — refers to the process in which non-governmental sectors become
increasingly involved in the financing and provision of health care services, which
includes outright sale, public-private partnerships, corporatization, contracting

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out of equipment and services, joint venture, franchising, management control
and/or corporatization, leasing; and user-charges

Progressive health system — people-centered health development anchored on the
needs and demands of the people, and with the interest of the people as paramount.
People’s participation is a necessary component in establishing and maintaining a
forward-looking and responsive health care system that takes into consideration
socioeconomic factors such as land, food, jobs, wages, housing and
socio-economic rights that affect health must be taken into consideration and be
developed together.

Publicly-funded — a health system financed entirely by general government
revenues to meet the cost of all or most health care needs of citizens from a
publicly-managed allocated health care fund and not through private
payments/contributions made to insurance companies or directly to health care
providers in the form of social health insurance premiums, co-payments or
deductibles

t) Renationalization — reversion to the national government of the governance and
dispensation of health services previously devolved to the local government units
which shall include the control, direction, supervision, management, maintenance
and disposition of health personnel, facilities, programs and services

Secondary care/level of services — medical care that is provided by a specialist
upon referral by a primary care physician, usually based in a hospital or clinic,
though some may be community-based, requiring more specialized knowledge or
equipment such as planned operations, rehabilitative services

Tax-financed health system -- those in which more than half of public expenditure
is financed through revenues other than earmarked payroll taxes (deductions; as
distinguished from social health insurance or social security) and in which access
to publicly-financed services is open to all citizens

w) Tertiary care/level of services — highly specialized medical care usually over an
extended period of time that involves advanced and complex procedures for
treatments performed by specialists in state-of-the-art facilities, requiring
specialized knowledge and more intensive monitoring

Traditional medicine — refers to the sum total of health knowledge, skills,
practices and approaches based on the theories, beliefs and experiences indigenous
to different cultures, incorporating plant, animal and mineral-based medicines,
manual techniques, exercises, and psychospiritual therapies, applied singularly or
in combination to maintain physical and psychosocial well-being, as well as in
prevention, diagnosis, treatment, rehabilitation and palliation of physical and
mental illness

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SEC. 5. Prioritization and simultaneous implementation. — The Department of Health
(DOH) shall exert all efforts to simultaneously provide universal, free, comprehensive,
quality health services through a progressive, people-centered, integrated, national health
system that is publicly funded. Within 30 days after publication of this Act in the


Official Gazette, the DOH shall create the appropriate implementing arms and necessary
mechanisms in order to carry out the simultaneous implementation of this Act at all levels
of governance giving priority to health facilities mentioned in Chapter IV of this Act.

CHAPTER II. FREE HEALTH CARE IN PUBLIC HEALTH FACILITIES

SEC. 6. Free health care in public health facilities. All public hospitals and facilities
covered by this Act shall provide access to basic health care services and medically
necessary health services with no out-of-pocket expenses, financial or other barriers, and
without direct charges to patients at the point of service. The health facilities providing
free health services shall be publicly funded and supported by the national government
and the DOH through the annual General Appropriations Act that set overall expenditure
targets or limits as opposed to fee-for-service arrangements.

Free health services in public health facilities shall be available to all Filipino
citizens. Indigent persons and other disadvantaged individuals shall be provided
transportation, food and accommodation to the health facility while undergoing
treatment.

Public health facilities shall provide comprehensive health care, including health
promotion, health education, disease prevention, diagnosis and treatment of diseases,
drugs and devices, rchabilitation and palliative health services, through post-confinement
and follow-up consultations, outpatient and in-patient care, and continuing treatment or
management. These health services shall be rendered by appropriate health facilities from
primary, secondary to tertiary levels at center-based, community or hospital settings and
specialty centers, including emergency hospitals, birthing centers, municipal and city
health centers, barangay health stations.

SEC. 7. Free Medicines in Public Hospitals and Health Facilities. — As part of its
National Drug Policy the State shall formulate a Pharmaceutical Benefit Scheme (PBS)
based on the updated National Pharmaceutical Formulary. The PBS shall list the brand
name, generic, biologic and bio-similar medicines identified as essential and life-saving
drugs which shall be provided free to patients in public health facilities. All products to
be included in the PBS shall be assessed to be safe and effective by independent medical
experts, The PBS shall also include access to medically necessary drugs and devices,
vaccines for the national immunization program, medical devices, organ and tissue
transplants and a secure supply of safe blood products.

Prescription drugs administered in hospitals shall be provided at no cost to the
patient. Outside of the hospital setting, local health facilities shall be responsible for the
administration of the publicly funded PBS.


SEC. 8. Provision of equal and timely access to health education, basic preventive,
curative, rehabilitative, palliative health services. —

a) Emphasis of health care shall be on discase prevention and promotion of general
health, wellness and environmental health through major mass health campaigns
on health education, nutrition, immunization, environmental health and sanitation
Various levels of health facilities shall ensure regular screening programs for all
stages of the life cycle

All public health facilities shall ensure appropriate and timely treatment of
prevalent and endemic diseases, illnesses, injuries and disabilities, geriatric and
other forms of specialized care, preferably at community level

Public hospitals and health centers shall provide essential medicines and modes of
treatment that are free, safe, efficacious, accessible, and culturally acceptable

All public facilities shall ensure appropriate mental health education and
treatment, psycho-social support services and care

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CHAPTER III. NATIONAL PUBLIC HEALTH SYSTEM

SEC. 9. National Public Health System. — The governance, organization and structure of
the country’s public health system shall be reorganized into an integrated public health
care system from the barangay, municipal, city, provincial and regional up to the national
level including specialty hospitals, diagnostic facilities and health programs. The general
direction, policies, organizational and financial management, including budget of the
health system shall emanate from DOH Central Office.

These health services shall include outpatient and inpatient clinical services
including all types and modalities of health promotion and maintenance, discase
prevention and treatment covering curative, rehabilitative and palliative care. All public
health institutions shall implement a holistic, scientific, biopsychosocial, culturally
acceptable, community-based approach utilizing modern, traditional, complementary and
alternative modalities of health care.

SEC. 10. Community-based primary care. - Community-based primary care shall be
given prime importance as the core strategy of basic services to be provided at the
barangay stations and local health facilities. The DOH and local health authorities shall
ensure implementation of the following:

a) Education on prevailing health problems and methods for their prevention and

control;

b) Promotion of proper nutrition and food supp!

c) Adequate supply of safe water and basic sanitation;

d) Women’s and children’s health, including reproductive health care services;

e) Immunization against major infectious diseases;



f) Prevention and control of locally endemic diseases;
g) Appropriate treatment of common diseases and injuries; and
h) Provision of essential drugs.

Community-based health teams composed of trained local health workers, nurse
and physician shall be responsible for regular and timely basic health services for
families and communities within their designated geographic catchment area. These
community-based health teams shall adhere to the World Health Organization’s standard
ratio of physician per population and ensure the appropriate ratio of one barangay health
worker (BHW) for every 15-25 families.

SEC. 11. Palliative care, - Palliative care shall be rendered in a variety of settings, such
as hospitals or long-term care facilities, hospices, in the community and at home.
Palliative care focusing on those nearing death and on their families shall include medical
and emotional support, pain and symptom management, help with community services
and programs, and bereavement counseling.

SEC. 12. Facilitated referral system. — A facilitated referral system shall be
implemented efficiently to ensure continuity of care and avoid delays and prolonged
waiting times in rendering appropriate definitive treatment. All public health facilities
shall ensure the smooth flow of the referral pathway from the barangay to the local health
facilities, emergency clinics, and if medically necessary, on to higher levels of care such
as district or secondary general hospitals or up to tertiary or specialized hospital care with
initial screening by the primary care health worker.

SEC. 13. Free oral and dental health care services. — Oral and dental health care
services shall be provided free in all health facilities and hospitals. These include
promotion, prevention and essential dental procedures and devices necessary for normal
function.

SEC. 14, Free reproductive health care services. — Reproductive health care in varying
forms and degrees of complexity shall be provided for free in all levels and components
of the health system as mandated by the Republic Act No. 10354 or the Reproductive
Health Law of 2012.

SEC. 15. School-based health services. - The DOH shall institute and implement
school-based health services in coordination with the Department of Education (DepEd)
and the Commission on Education (CHED) to ensure adequate personnel deployment and
resources as well as school health programs such as mental health psycho-social services,
dental services, nutrition, immunization and health education.

SEC. 16. Other sectoral health initiatives. — For other intersectoral health initiatives
such as services for Occupational Health and Safety, Environmental Health concerns, the


DOH shall coordinate with the concemed government agencies such as the Department
of Labor and Employment (DOLE), the Department of Agriculture (DA) and the
Department of Environment and Natural Resources (DENR) to ensure appropriate and
timely interventions and programs.

SEC. 17. Emergency Medical Services. - The DOH shall develop and strengthen
Emergency Medical Services at all levels of the health care system from the barangay to
the municipal/city, regional and national health facilities. Each facility shall formulate
and implement the applicable emergency health care services according to its capacity
based on guidelines from the DOH Central Office. The DOH shall provide the
mechanisms for the necessary capacity building, personnel training, supplies and
equipment, including transport systems, of public health facilities at various levels.

SEC. 18. Renationalization of health services, facilities and programs. — All health
services, facilities and programs devolved to the local government units are hereby
renationalized and retuned to the national government.

For this purpose the following pertinent provisions of the Local Government Code
of 1991 (R.A. 7160) are hereby repealed, deleted and declared no longer enforceable and
effective: Section 17 (b) paragraph (1) (ii), paragraph (2) (iii), paragraph (3) (iv) and (4)
for health services only; Section 102 (a) (1), (2), (3), (b) (1), (2) and (3): Section 103 (a)
and (b); Section 104; Section 105; and all other related provisions of the Local
Government Code that pertains to devolved health services and facilities.

SEC. 19. Renationalization of government-owned and -controlled corporations,
hospitals and health facilities. — All government-owned and -controlled corporation
(GOCC) hospitals, privatized and corporatized public hospitals and health facilities shall
be reverted back to the direct control of the government through the DOH as part of the
integrated public health system. The primary and overriding goal of these health facilities
shall be the provision of free health services to the public as part of publicly funded social
services.

Health facilities and entities to be included are district and emergency hospitals,
specialty hospitals and medical centers, diagnostic and research facilities, centers for
research, development and production of biologicals and medical tools, equipment and
supplies.

These health facilities shall undergo transition measures to dissolve existing
revenue-generating business-oriented corporate structures and transfer ownership and
administration of operations to boards of trustees or regional health authorities
established by the DOH in coordination with provincial or regional government units.
The period of transition for transfer and reorganization shall be within three (3) years
from the enactment of this Act.


For this purpose, the following charters of GOCC hospitals are hereby repealed
and declared no longer enforceable and effective: Presidential Decree No. 673 S. 1975,
Presidential Decree No. 1823 s. 1981, and Presidential Decree No. 1832 s. 1981.

SEC. 20. Strengthening and building health facilities. All existing specialty hospitals
and facilities shall undertake organizational audit, strategic assessment and planning to
identify gaps and weaknesses in the performance and implementation of their mandate,
mission and goals and recommend the necessary reforms for improved provision of
health services.

Mental health services, centers and facilities shall be installed in all levels of the
health care system as mandated by the Republic Act No. 11036 or the Philippine Mental
Health Act of 2017. Mental health centers and facilities shall be provided in all the
regions of the country for outpatient and inpatient mental health and psychosocial
interventions ranging from promotion, maintenance, curative and rehabilitative services.

SEC. 21. Creation of Center for Disease Control. — The DOH shall create a Center for
Disease Control with epidemiologic and surveillance units, and satellite centers of the
Research Institute of Tropical Medicine in all regions of the country.

SEC. 22. Regulation of private practice and health maintenance organizations. —
Private practice and health maintenance organizations shall be allowed subject to State
regulation.

CHAPTER IV. HEALTH FACILITIES

SEC. 23. Health facilities at all levels of care. — In order to provide a public health
system anchored on a community-based approach to health care that is strengthened and
developed from the barangay to town/city, district, provincial, regional and national
levels using public funds, the State, through the DOH shall ensure the following:.

a. Setting up and operationalization of at least 1 health station for every
barangay. Rehabilitation of existing barangay health stations.
b. Establishment of 1 primary care facility within 30 minutes of travel per
20,000 population size.
c. Establishment of general and specialty hospitals.
1. Level 1 or 2 hospitals with a minimum bed-to-population ratio of 2.7
per 1,000.
2. Level 3 hospital with a minimum of all Level 2 capacity including
but not limited to the following: teaching and/or training hospital
with accredited residency training program for physicians in the four


(4) major specialties namely: medicine, pediatrics, obstetrics and
gynecology, and surgery; provision for physical medicine and
rehabilitation unit; provision for ambulatory surgical clinic;
provision for dialysis facility; provision for blood bank;
DOH-licensed | tertiary clinical laboratory with standard
equipmentreagents/supplies necessary for the performance of
histopathology examinations; DOH-licensed level 3 imaging facility
with interventional radiology

3. One (1) hospital bed per 1,000 population (1:1,000). In a province
or region (e.g. NCR) where the bed to population ratio is already
more than 1:1,000, additional beds may be put up if the average
occupancy rate for all hospitals for the past two (2) years is more
than 85%. The number of beds that may be put up shall be based on
the health care needs of the population. The hospital shall be at most
one (1) hour away by the usual means of transportation at most parts
of the year. Services will include clinical services (family medicine,
pediatrics, internal medicine, obstetrics and gynecology, surgery),
emergency services, outpatient services, ancillary and support
services such as clinical laboratory, imaging facility and pharmacy.

4. Specialty hospital

. Provision of adequate medicines, supplies, equipment, and highly

specialized medical equipment such as x-ray, CT Scan, MRI, and LINAC
based on needs identified by the Department

. Establishment of other health facilities based on population needs:

1. Custodial Care Facility - a health facility that provides long-term
care, including basic human services like food, shelter to patients
with chronic or mental illness, patients in need of rehabilitation
owing substance abuse, people requiring ongoing health and nursing
care due to chronic impairments and a reduced degree of
independence in activities of daily living. Examples of such facilities
are but not limited to the following:

i. Custodial Psychiatric Care Facility

ii, Substance/Drug abuse Treatment and Rehabilitation Center
iii, Sanitarium/Leprosarium

iv. Nursing Home

2. Diagnostic/Therapeutic Facility — a facility that examines the human
body or specimens from the human body (except laboratory for
drinking water analysis) for the diagnosis, sometimes treatment of
diseases. The test covers the pre-analytical, analytical, and
post-analytical phases of examination

i. Laboratary Facility, such as but not limited to the following:
1. Clinical laboratory
2. Human Immunodeficiency Virus Testing Laboratory



3. Blood service facility
4. Drug testing laboratory
5. Newborn screening laboratory
6. Laboratory for drinking water analysis
ii, Radiologic facility, such as but not limited to equipment and
highly specialized medical equipment such as x-ray, CT Scan,
MRI, and LINAC based on needs identified by the
Department
3. Nuclear Medicine Facility — a facility presently regulated by PNRI,
embracing all applications of radioactive materials in diagnosis,
treatment or in medical research, with the exception of the use of
sealed radiation sources in radiotherapy.

CHAPTER V. NATIONAL HEALTH INDUSTRY

SEC. 24, Health technology. - The DOH through its Health Technology Assessment
Council shall come up with updated inventory of health technology needs, such as
biologicals and pharmaceuticals, medical supplies and equipment, diagnostic technology
and supplies, and its sources, and identify together with the Department of Science and
Technology - Philippine Council for Health Research and Development (DOST-PCHRD)
our own appropriate technology that can be researched and developed. Provided that the
research and development of the technology will be funded by the Philippine
government.

SEC. 25. National Pharmaceutical Industry. — The State shall ensure that all Filipinos
have access to quality essential medicine. For this purpose, the Department of Trade and
Industry (DTI), in full cooperation with the DOH, shall create a National Pharmaceutical
Industry that shall:

a) Develop technology that will extract and refine raw materials and chemicals for
medicine production;

b) Continue and strengthen the local production of medicinal plants, and assess the
current state of herbal processing plants and improve further the potentials of
herbal medicine and natural components that can be found in the Philippines;

c) Selective parallel importation of essential medicines that are more affordable and
have gone through extensive government testing for safety and efficacy; and

4) Compulsory licensing that will permit the sale and manufacture of needed
medicines notwithstanding the existence of their patents.

Provided, that local pharmaceutical manufacturers are entitled to fiscal incentives subject
to the Implementing Rules and Regulations.


For this purpose, the following charters of GOCC hospitals are hereby repealed
and declared no longer enforceable and effective: Presidential Decree No. 673 S. 1975,
Presidential Decree No. 1823 s. 1981, and Presidential Decree No. 1832 s. 1981.

SEC. 20. Strengthening and building health facilities. -Al\ existing specialty hospitals
and facilities shall undertake organizational audit, strategic assessment and planning to
identify gaps and weaknesses in the performance and implementation of their mandate,
mission and goals and recommend the necessary reforms for improved provision of
health services.

Mental health services, centers and facilities shall be installed in all levels of the
health care system as mandated by the Republic Act No. 11036 or the Philippine Mental
Health Act of 2017. Mental health centers and facilities shall be provided in all the
regions of the country for outpatient and inpatient mental health and psychosocial
interventions ranging from promotion, maintenance, curative and rehabilitative services.

SEC. 21. Creation of Center for Disease Control. ~ The DOH shall create a Center for
Disease Control with epidemiologic and surveillance units, and satellite centers of the
Research Institute of Tropical Medicine in all regions of the country.

SEC. 22. Regulation of private practice and health maintenance organizations. -
Private practice and health maintenance organizations shall be allowed subject to State
regulation.

CHAPTER IV. HEALTH FACILITIES

SEC. 23. Health facilities at all levels of care. — In order to provide a public health
system anchored on a community-based approach to health care that is strengthened and
developed from the barangay to town/city, district, provincial, regional and national
levels using public funds, the State, through the DOH shall ensure the following:.

a. Setting up and operationalization of at least 1 health station for every
barangay. Rehabilitation of existing barangay health stations.
b. Establishment of 1 primary care facility within 30 minutes of travel per
20,000 population size.
c. Establishment of general and specialty hospitals.
1. Level 1 or 2 hospitals with a minimum bed-to-population ratio of 2.7
per 1,000.
2. Level 3 hospital with a minimum of all Level 2 capacity including
but not limited to the following: teaching and/or training hospital
with accredited residency training program for physicians in the four


(4) major specialties namely: medicine, pediatrics, obstetrics and
gynecology, and surgery; provision for physical medicine and
rehabilitation unit; provision for ambulatory surgical clinic;
provision for dialysis facility; provision for blood bank;
DOH-licensed tertiary clinical laboratory with standard
equipmentreagents/supplies necessary for the performance of
histopathology examinations; DOH-licensed level 3 imaging facility
with interventional radiology

3. One (1) hospital bed per 1,000 population (1:1,000). In a province
or region (e.g. NCR) where the bed to population ratio is already
more than 1:1,000, additional beds may be put up if the average
occupancy rate for all hospitals for the past two (2) years is more
than 85%, The number of beds that may be put up shall be based on
the health care needs of the population. The hospital shall be at most
one (1) hour away by the usual means of transportation at most parts
of the year. Services will include clinical services (family medicine,
pediatrics, internal medicine, obstetrics and gynecology, surgery),
emergency services, outpatient services, ancillary and support
services such as clinical laboratory, imaging facility and pharmacy.

4. Specialty hospital

|. Provision of adequate medicines, supplies, equipment, and highly
specialized medical equipment such as x-ray, CT Scan, MRI, and LINAC
based on needs identified by the Department

.. Establishment of other health facilities based on population needs:

1. Custodial Care Facility — a health facility that provides long-term
care, including basic human services like food, shelter to patients
with chronic or mental illness, patients in need of rehabilitation
owing substance abuse, people requiring ongoing health and nursing
care due to chronic impairments and a reduced degree of
independence in activities of daily living. Examples of such facilities
are but not limited to the following:

i. Custodial Psychiatric Care Facility

ii, Substance/Drug abuse Treatment and Rehabilitation Center
iii, Sanitarium/Leprosarium
iv. Nursing Home

2. Diagnostic/Therapeutic Facility — a facility that examines the human
body or specimens from the human body (except laboratory for
drinking water analysis) for the diagnosis, sometimes treatment of
diseases. The) test covers the pre-analytical, analytical, and
post-analytical phases of examination

i, Laboratory Facility, such as but not limited to the following:
1. Clinical laboratory
2. Human Immunodeficiency Virus Testing Laboratory


a) The government shall promote and protect the basic rights of health
workers as enshrined in the 1987 Philippine Constitution, , R.A 7305 or
Magna Carta of Public Health Workers, Executive Order 180, s. 1987 and
other related international laws such as the Universal Declaration of Human
Rights, UN General Assembly Resolution 217 A, Dec. 1948 and
International Labor Organization Convention Nos. 87 and 98.

b) The State shall protect the right to security of tenure to all health workers
working in public and private hospitals and other health facilities. Health
workers employed in a hospital or health facility are vital to the operations
of the hospital so they shall not be contractualized in any form of temporary
tenure;

¢)

The State shall protect the right to humane conditions of work such as
health workers to patient ratio depending on equity, an 8 hour per day shift
to complete 40 hours per week and free from all forms of discrimination
and bullying at work.

d) The State shall ensure health workers’ protection and safety while on duty,
and shall provide personal protective equipment (PPE), free transportation
and accommodation during pandemic, disasters, other public health crisis,
and uncertain hours going to and from home to hospital.

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The State shall ensure that health workers both in public and private clinics
and hospital and other health facilities, from national to local government
units shall have the right to living wage/salaries and benefits such as those
mandated under the Magna Carta for Public Health Workers with no
discrimination. Provided that the health workers in the private sector are
entitled to wages/salaries equivalent to the salary received by entry-level
health workers in the public sector. Provided further that barangay health
workers are entitled to incentives for development, collectively to be given
to BHW organization (i.e. cooperative).

f) The State shall promote and recognize the right to self-organization,
collective bargaining and negotiations of private and public health workers
unions or associations and their management.

g) The State shall recognize public and privately employed health workers on
the right to peaceful concerted actions including the right to strike.


h) The State shall recognize the health workers’ right to form unions or
associations of public and private health workers, to participate in policy
and decision-making affecting their rights and right to health of the people.

The Department of Health through its Health Human Resources Bureau
shall develop and implement a continuing education program to enhance
the skills and knowledge of all health workers working both in public and
private health facilities,

j) The State shall ensure that benefits embodied under R.A. 7305 and other
special benefits provided by the government shall be given to all public and
private health workers,

k) The State shall recognize the right to free continuing professional
development

1) The State shall protect and ensure the safety of all health workers at all
times against any human rights violations namely harassment, beatings,
torture, inhumane and degrading punishments, killings, disappearance,
detention, prosecution, as well as more insidious threats and obstructions to
healthcare access.

m) The State shall allocate funds for scholarships including books, dorm rents,
transportation and food allowances.

CHAPTER VIII. HEALTH-RELATED INFORMATION AND EDUCATION
SEC. 29. Health sciences education. —

a) The State shall ensure that health sciences education is free, nationalist, scientific,
and people-centered. Health sciences education nationwide will serve the needs of
the public health system and the government's overall plan for health workers in
the country;

b) The State shall not prohibit students and professionals from taking up additional
courses or programs to qualify for their desired employment or career
development;

c) The State shall ensure that health sciences schools, university, colleges and
institutions shall be established in every region based on the needs of the
population coverage;


d) The DOH shall coordinate with all health sciences schools/colleges/
‘universities/institution all over the country to have a unified data/number of health
science students and monitor the number and quality of health science education
facilities nationwide;

©) The DOH shall coordinate with CHED and other stakeholders in health like
non-government organizations to review and formulate/create new health sciences
modules/curriculum that shall encourage students to serve in the country;

f) The State through the CHED shall ensure the accreditation of all health sciences

school, university, colleges and institutions to ensure the quality and standard of
education; and

g) The State shall allocate funds for scholarships including books, dorm rents,
transportation and food allowances.

SEC. 30. Health information and education. — The State shall ensure that the people
have access to timely and important health information and education through maximum

and meaningful community participation to ensure enlightened and empowered
communities,

a) The State shall ensure that the designated health worker together with the
barangay health committee, and community volunteers shall work together to
generate data as basis for community planning for needs-based intervention;

b) The DOH shall ensure that the health information provided to the people shall be
gender and culture sensitive; and

c) The DOH shall conduct regular updates and training to be given to community
health teams and volunteers/Barangay Health Emergency Response
Team/Barangay Health Worker

SEC. 31. Electronic medical records. - The DOH shall ensure the establishment and
institutionalization of electronic medical records in all levels of health care at different
periods of time, subject to the Implementing Rules and Regulations.

CHAPTER IX. HEALTH FINANCING

SEC. 32. Financing of the Philippine Health Care System. - The primary mode of
financing the health care system shall be government appropriation for public health care
as part of the DOH budget and the annual General Appropriations.


The National Health Insurance Program and its implementing agency the
Philippine Health Insurance Corporation (PhilHealth) shall be abolished within three (3)
months after the enactment of this Act. All the assets, infrastructure, personnel and
budget of PhilHealth shall be transferred to the DOH for disposition and allocation in
accordance with the provisions stipulated in this Act.

SEC. 33. Appropriations. — The amount necessary for the initial implementation of this
Act shall be Four Hundred Forty One Billion Two Hundred Forty Nine Million Nine
Hundred Eighty Six Thousand Eight Hundred Twenty (P441,249,986,820.00) that shall
be added to the appropriations of the DOH.

Thereafter, such sums may be needed for its continued implementation shall be
included in the Annual General Appropriations Act including the amount sourced from
the following:

a) Total incremental sin tax collections as approved for in Republic Act No. 10351,
otherwise known as the “Sin Tax Reform Law.” Provided that the mandated
earmarks as provided for in Republic Act Nos. 7171 and 8240 shall be retained;
Fifty percent (50%) of the National Government share from the income of the
Philippine Amusement Gaming (PAGCOR) as provided for in Presidential Decree
No. 1869, as amended;

Forty percent (40%) of the Charity Fund, net of Documentary Stamp Tax

Payments, and mandatory contributions of the Philippine Sweepstakes Office

(PCSO) as provided for in Republic Act No. 1169, as amended;

d) Fifty percent (50%) of the breakage and share from franchise tax and other taxes
of the Manila Jockey Club, Inc. as approved for Republic Act No. 6631, as
amended;

¢) Fifty percent (50%) of the breakage and share from franchise tax and other taxes
of the Philippine Racing Club, Inc. as approved for Republic Act No. 6632, as
amended;

f) Fifty percent (50%) of the income from quarantine services as approved by

Republic Act No. 9271, otherwise known as the “Quarantine Act of 2004;”

Income collection from fees, fines, royalties and other charges as approved by

Republic Act. No. 3720, otherwise known as the “Food, Drug, and Cosmetic Act”

and Republic Act No. 9502, otherwise known as the “Universally Accessible

Cheaper and Quality Medicines Act of 2008;”

b

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g

The amount necessary for the implementation of the provisions of this Act shall be
included in the General Appropriations Act and shall be appropriated under the budget of
the DOH every year.


CHAPTER X. PROHIBITED ACTS AND PENAL PROVISIONS

SEC, 34. Prohibition of privatization of public health facilities, hospitals and health
services. — No public health facility, hospital and health service shall undergo
privatization in any form. This includes prohibition of transformation to corporate
entities, contracting of services to private agencies, public-private partnership, hiring or
leasing of equipment and devices from commercial entities. This prohibition also
includes the following:

a) Divestiture or outright sale of public sector assets in which the state divests itself
of public assets to private owners;

b) Franchising or contracting out to private, for profit, or not-for-profit providers;

c) Self-management, wherein providers are given autonomy to generate and spend
resources;

d) Market liberalization or deregulation to actively promote growth of the private
health sector through various incentive mechanisms; and

Withdrawal from State provision, wherein the private sector grows rapidly as a

result of the failure on the part of the government to meet the healthcare demands

of the people.

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Under no circumstances shall the Secretary of Health or any person, whether
natural or juridical, initiate, cause, and approve the privatization of any public health
facility, hospital or health service. Any person, whether natural or juridical, who initiates,
causes or approves the privatization of any public health facility, hospital or health
service shall be considered in violation of this Section.

SEC. 35. Other prohibited acts. — The following acts are prohibited:

a)

Collecting fees from patients in exchange for the provision of health services
and medicines, selling supplies, and medicines, and other use fee schemes in
public health facilities;

Withholding or purposely delaying procedures and services, supplies,
medicines to patients for reasons of no funds, supplies or equipment;

c) Renting out hospital equipment to patients;

4) Allowing or contracting out to private companies the sale and provision of
supplies. services and medicines within the public hospital or health premises;
Generating income from patients in whatever forms or means;

f) Forcing health workers to work beyond duty hours in the absence of justifiable
reasons and without mandated benefits and protection.

b)

2

SEC. 36. Penalties. — The following penalties shall be imposed upon any person found
guilty of violating Sections 34 and 35 of this Act:


a) First Offense — A fine not less than one hundred thousand pesos (P100,000.00) but
not more than two hundred thousand pesos (P200,000.00). If the offender is a

public official, suspension of one year to two years from public office;

Second Offense — A fine not less than two hundred thousand pesos (P200,000.00)

but not more than five hundred thousand pesos (P500,000,00). If the offender is a

public official, suspension of three years but not more than six years from public

office; and

c) Third Offense — A fine not less than five hundred thousand pesos (P500,000.00)
but not more than eight hundred thousand pesos (P800,000.00). If the offender is a
public official, removal from public office and perpetual disqualification from
holding any public position or office.

b)

CHAPTER XI. TRANSITORY PROVISIONS

SEC. 37, Transition period. — Pertinent government and agencies and instrumentalities
shall be given two years to fully implement free and no cash-out health care services. in
all public health facilities, Other provisions of this Act shall be fully implemented within
five years from the approval of this Act.

SEC. 38. Information Dissemination. - The DOH shall conduct an education drive and
information dissemination campaign from barangay to national level of the provisions of
this Act.

SEC. 39. Tax holidays and incentives to local private hospitals and facilities. - Tax
holiday and incentives shall be provided to local private hospitals and facilities in areas
where no public health facility is situated, provided that they such facilities allot certain
portion of their bed capacity for indigent patients and provide free services to such
indigent patients.

Provided further, that such tax holidays and incentives shall be reviewed and adjusted
accordingly when adequate public health facilities are established in the area.

CHAPTER XI. FINAL PROVISIONS

SEC. 40. Implementing rules and regulations. — Where needed and applicable,
Implementing Rules and Regulations shall be crafted and promulgated by the DOH
within the 120 days from the effectivity of this Act to carry out the objectives of its
programs.


SEC. 41. Separability clause. — If, for any reason or reasons, any part or provision of
this Act shall be declared as unconstitutional or invalid, the other parts or provisions
hereof which are not affected thereby shall continue to be in full force and effect.

SEC. 42. Repealing clause. — All provisions of existing laws, orders, rules and
regulations or parts thereof including Presidential Decree No. 1631, s. 1979 and Republic
Act No. 7875, which are in conflict or inconsistent with the provisions of this Act are
hereby repealed, amended or modified accordingly.

SEC. 43. Effectivity clause. — This Act shall take effect immediately upon its publication
in the Official Gazette or in at least two (2) newspapers of general circulation in the
Philippines.

Approved,