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Republic of the Philippines
HOUSE OF REPRESENTATIVES

i 1
FIFTEENTH CONGRESS
PIRST REGULAR SESSION

HOUSE BILL NO. _ 16: 1 2

Introduced by HON. MARIA MILAGROS “MITOS” H. MAGSAYSAY

EXPLANATORY NOTE

Itis the declared policy of the state to improve the quality and delivery of health
care services to the citizenry, a policy now enunciated expressly in several of the
government’s health laws. This is rooted in the constitution which directs the State to
“adopt an integrated and comprehensive approach to health development which shall
endeavor to make essential goods, health and other social services available to all people
at affordable cost.”

However, one area which has yet to be clearly included in this “comprehensive
approach (o health development” and made “available to all people at affordable cost” is
the field of traditional and alternative medicine and health care. While we already have
Republic Act No. 8423, approved December 9, 1997 creating the Philippine Institute of
Traditional and Alternative Health Care and seeking to accelerate the development of
traditional and alternative health care , the thrust is essentially still in the direction of
research, development and policy formulation for which a Traditional and Alternative
Health Care Development Fund have been established. ‘The inclusion of traditional
medicine and “traditional healers” or herbal medicine ‘and “herbal doctors” in the
coverage of PHILHEALTH for purposes of extending affordable health care services to
the people is yet (o be realized.

Recent studies around the world have confirmed at least two things: (1) herbal
medicines are the staple of medical treatment in many developing countries and literature
abounds “with efficacy and safety studies of many herbal medicines"; and (2). the
increased use of herbal medicines - as sown by historical and empirical evidence - has
“potential for improving public health and lowering health care costs.”

Here at home, Filipinos have always turned to plants and nature to seek cures for
their illness. It is recognized even by medical authorities that a significant segment of our


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people, not necessarily limited to the rural areas, have resorted to or availed of traditional
medicine and/or herbal treatment to help maintain and improve their health or cure their
ailments, The impact of traditional medical treatment — and the wonders of herbal
treatment, if you will - on public health care is clearly there for all to appreciate. But
this recognition is not matched by the inclusion of traditional medicine or herbal
medicine practitioners or facilities institutions or community-based organizations having
them as a qualified health care provider_under Republic Act No. 7875 ( National Health
Insurance Program), as amended by RA No. 9241, which is what public health care is all
about.

‘The attached bill therefore seeks to amend existing laws to have this realized, by
including professionals engaged in traditional medical treatment or herbal treatment,
respected and recognized people or institutions in the community with a profound
knowledge or acknowledged expertise in traditional or herbal medicines, as a qualified
health care provider. This would not be subject (o abuse, as some medical practitioners
fear, because strict safeguards will be in place. The proposed legislation thus would have
the Department of Health and the PITAHC and PHILHEALTH promulgate the rules and
regulations , the standards and guidelines to assure the strict implementation of the law
and achieve the basic objective of providing lower costs of health services

In this context, approval of the bill is earnestly sought.

at

MARIA MILAGROS “MITOS” H. MAGSAYSAY



Republic of the Philippines
HOUSE OF REPRESENTATIVES

| FIPPEENTH CONGRESS |
| FIRST REGULAR SESSION 35
i

nouse BiLL'to,__ 1612

Introduced by HON. MARIA MILAGROS “ MITOS” H, MAGSAYSAY

AN ACT
FURTHER AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS “AN
ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM FOR ALL.
FILIPINOS AND ESTABLISHING THE PHILIPPINE HEALTH INSURANCE
CORPORATION FOR THE PURPO:

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

SECTION I. Declaration of Policy - It is hereby the declared policy of the State
to recognize the use and advocacy of alternative health care , traditional and herbal
medicines and healing methods as safe, reliable and effective health services and to
integrate them into the government’s national health insurance program consistent with
the mandate of the State to adopt an integrated and comprehensive approach to health
development and to make available health services to all people at affordable costs.

OUSENE

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SEC. 2. Section 4 of Republic Act No. 7875 is hereby further amended to read as
8 follows :

9 “Sec, 4. Definition of Terms. —For the purpose of this Act, the following terms
10 shall be defined as follows:

i a) Beneficiary — Any person entitled to health care benefits under this Act.

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H.B. NO. 1612

b) Benefit Package — Services that the Program offers to its members.

©) Capitation ~ A payment mechanism where a fixed rate, whether per person,
family, household, or group, is negotiated with a health care provider who
shall be responsible for delivering or arranging for the delivery of health
services required by the covered person under the conditions of a health care
provider contract.

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Contribution — ‘The amount paid by or in behalf of a member to the Program
for coverage, based on salaries or wages in the case of former sector
employees, and on household earnings and assets, in the case of self-
employed, or on other criteria as may be defined by the Corporation in
accordance with the guiding principles set forth in Article 1 of this Act

e) Coverage — The entitlement of an individual, as a member or as a dependent,
to the benefits of the Program.

Dependent ~ The legal dependents of a member are: 1) the legitimate spouse
who is not a member; 2) the unmarried or unemployed legitimate, legitimated,
illegitimate, acknowledged children as appearing in the birth certificate;
legally adopted or stepchildren below twenty-one (21) years of age; 3)
children who are twenty-one (21) years old: or above but suffering from
congenital disability, either physical or mental, or any disability acquired that
renders them totally dependent on the member for support; 4) the parents who
are sixty (60) years old or above whose monthly income is below an amount
to be determined by the Corporation in accordance with the guiding principles
set forth in Article I of this Act.

8) Diagnostic Procedure - Any procedure (o identify a disease or condition

through analysis and examination,

Emergency ~ An unforeseen combination of circumstances which calls for
immediate action to preserve the life of a person or to preserve the sight of
one or both eyes; the hearing of one or both ears; or one or two limbs at or
above the ankle or wrist.

i) Employee — Any person who performs services for an employer in which
either ot both mental and physical efforts are used and who receives

compensation for such services, where there is an employer-employee
relationship.

i) Employer ~ A natural or juridical person who employs the services of an
employee.

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Enroliment — The process to be determined by the Corporation in order to
enlist individuals as members or dependents covered by the Program.



HB. NO. 1612

L 1) Fee for Service — A reasonable and equitable health care payment system
2 under which physicians and other health care providers receive a payment that
3 does not exceed their billed charge for each unit of service provided.
f m) Global Budget — An approach to the purchase of medical services by which
5 health care provider negotiations concerning the costs of providing a specific
6 package of medical benefits is based solely on a predetermined and fixed
7 budget.
8 n) Government Service Insurance System — The Government Services Insurance
9 System created under Commonwealth Act No. 186, as amended.
10 0) Health Care Provider — Refers to:
at (1) a health care institution, which is duly licensed and accredited devoted
12 primarily to the maintenance and operation of facilities for health
13 promotion, prevention, diagnosis, treatment, and care of individuals
14 suffering from illness, disease, injury, disability or deformity, drug
15 addiction or in need of obstetrical or other medical and nursing care.
16 It shall also be construed as an institution, building, or place where
17 there are installed beds, cribs, or bassinets for twenty-four hour use or
18 longer by patients in the treatment of diseases, injuries, deformities, or
19 | and mental states, maternity cases or sanitarial
20 care; or infirmaries, nurseries, dispensaries, rehabilitation centers and
21 such other similar names by which they may be designated; or
22 (2) a health care professional, who is any doctor of medicine, nurse,
23 midwife, dentist, or other health care professional or practitioner duly
24 licensed to practice in the Philippines and accredited by the
25 Corporation; or
26 (3) a health maintenance organization, which is an entity that provides,
27 offers, or arranges for coverage of designated health services needed
28 by plan members for a fixed prepaid premium;
29 (4) a community-based health care organization, which is an association
i of indigenous members of the community organized for the purpose |
31 of improving the health status of that community through preventive,
32 promotive and curative health services;
33 (5) a health care professional or respected practitioner engaged in the
34 practice of alternative health care or treatment , traditional

35 medicine or healing by herbal medicines ; or



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(6) 2 community-based organization, an_association of indigenous
members of the community organized for_the purpose of
improving the health conditions of that community through (he
use of traditional medicine , alternative health care or herbal
healing or treatment services.

p) Health Insurance Identification (ID) Card ~ The document issued by the
Corporation to members and dependents upon their enrollment to serve as the
instrument for proper identification, eligibility verification, and utilization
recording.

q) Indigent - A person who has no visible means of income, or whose income is
insufficient for the subsistence of his family, as identified by the Local Health
Insurance Office and based on specific criteria set by the Corporation in
accordance with the guiding principles set forth in Article I of this Act.

1) Inpatient Education Package ~ A set of informational services made available
to an individual who is confined in a hospital to afford him with knowledge
about his illness and its treatment, and of the means available, particularly
lifestyle changes, to prevent the recurrence or aggravation of such illness and
to promote his health in general.

8) Member ~ Any person whose premiums have been regularly paid to the
National Health Insurance Program. He may be a paying member, an indigent
member, or a pensioner/retiree member.

1) Means Test - A protocol administered at the barangay level to determine the
ability of individuals or households to pay varying levels of contributions to
the Program, ranging from the indigent in the community whose contributions
should be totally subsidized by government; to those who can afford to
subsidize part but not all the required contributions for the Program.

u) Medicare ~The health insurance program currently being implemented by the
Philippine Medical Care Commission. It consists of :

(1) Program 1, which covers members of the SSS and GSIS including
their legal dependents; and

(2) Program II, which is intended for those not covered under Program I.

v) National Health Insurance Program — The compulsory health insurance
program of the government as established in this Act, which shall provide
universal health insurance coverage and ensure affordable, acceptable,
available and accessible health care services for all citizens in the Philippines.

w) Pensioner ~ An SSS or GSIS member who receives pensions therefrom.



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x) Personal Health Services — Wealth services in which benefits accrue to the

individual person. There are categorized into inpatient and outpatient
services.

y) Philippine Medical Care Commission — The Philippine Medical Care
Commission — The Philippine Medical Care Commission created under

Republic Act No. 6111, as amended.

2) Philippine National Drug Formulary ~ The essential drugs list for the
Philippines which is prepared by the National Drug Committee of the
Depatiment of Health in consultation with experts and specialists from
organized professional medical societies, medical academe and the
pharmaceutical industry and which is updated every year.

aa) Portability ~The enablement of a member to avail of Program benefits in an
area outside the jurisdiction of his Local Health Insurance Office.

bb) Prescription Drug - A drug which has been approved by the Bureau of Food
and Drug and which can be dispensed only pursuant to a prescription order
from a physician who is duly licensed to do so.

cc) Public Health Services ~ Services that strengthen preventive and promotive
health care through improving conditions in partnership with the community
at large. These include control of communicable and non-communicable
diseases, health promotion, public information and education, water and
sanitation, environmental protection, and health-related data collection,
surveillance, and outcome monitoring.

dd) Quality Assurance ~ A formal set of activities to review and ensure the quality
of services provided. Quality assurance includes quality assessment and
corrective actions to remedy any defici identified in the quality of direct
patient, administrative, and support services.

ce) Residence ~The place where the member actually lives.

ff) Retiree ~ A member of the Program who has reached the age of retirement or
who was retired on account of disability.

22) Self-employed — A person who works for himself and is therefore both
employee and employer at the same time.

hh) Social Security System — The Social Security System created under Republic
‘Act No. 1161, as amended.


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00) Herbal Medicines - finished, labeled, medicinal

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ii) Treatment Procedure ~ Any method used to remove the symptoms and cause
of a disease.

ji) Utilization Review — A formal review of patient utilization or of the
appropriateness of health care services, on a prospective, concurrent or
retrospective basis.

kk) Rehabilitation Center — Refers to a facility, which undertakes rehabilitation of
drug dependents. It includes institutions, agencies and the like which have for
their purpose, the development of skills, or which provides counseling, or
which seeks to inculcate, social and moral values to clientele who have a drug
problem with the aim of weaning them from drugs and making them drug
free, adapted to their families and peers, and readjusted into the community as
Jaw-abiding, useful and productive citizens.

Il) Home Care and Medical Rehabilitation Services — Refer (o skilled nursing
care, which members get in their homes/clinics for the (reatment of an illness
or injury that severely affects their activities or daily living. Home care and
medical rehabilitation services include hospice or palliative care for people
who are terminally ill but does not include custodial and non-skilled personal
care.

mm)

practice ion
diagnosis and ¢ STATE of physical or Eee disorder, which include
logy, acupuncture, massage, acupressure chiropractics,

products that contain as
active ingredient/s acrial_or underground _part/s of plant_or_other
ials pinatic ereof , whether in the crude state or as plant
preparations. Plant material includes es, gums, fatty oils, esse oils

and other substances of this nature .



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H.B. NO. 1612

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SEC. 3. Section 54 of the Act is hereby amended to read as follows:

“SEC. 54. Oversight Provision. — Congress shall conduct a regular review of the
National Health Insurance Program, which shall entail a systematic evaluation of the
Program’s objectives or goals. Such review shall be undertaken by the Committees of
the Senate and the House of Representative, which have legislative jurisdiction over the
Program,

‘The National Economic and Development Authority, in coordination with the
National Statistics Office and the National Institutes of Health of the University of the
Pailippine. including the Philippine I f Traditional and Alternative Health
1 the case of icine and herbal health

‘vices ,_ shall undertake studies to validate the accomplishments of the Program.

‘The budget required to undertake such study shall come from the income of the
Philtfealth.”

SEC. 4. Rules and Regulations - The Department of Health shall, upon the
recommendation of the Philippine Institute of Traditional and Alternative Health Care ,
the Philippine Health Insurance Corporation (PHILHEALTH) and the National
Institutes of Health of the University of the Philippines, promulgate the necessary rules
and regulations for the effective implementation of this Act. Implementation may initially
be done on a limited scale or pilot basis until such time that full and nationwide
implementaion may be warranted as may be properly determined by the Department of
Health in consultation with PHILHEALTH.

SEC. 5. Separability Clause ~ If any part or provision of this Act shall be held

unconstitutional or invalid, other provisions, which are not affected thereby, shall
continue to be in full force and effect.

SEC. 6  Effectivity — ‘This Act shall take effect fifteen (15) days after its
publication in at least three (3) national newspapers of general circulation..

Approved,