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Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

19% Congress
First Regular Session

House Bill No.4474

INTRODUCED BY: HON. DORIS E. MANIQUIZ

EXPLANATORY NOTE

Section 15, Article II of the 1987 Constitution provides that, “The States shall protect and
promote the right to health of the people and instill health consciousness among them”. Equally
important is the imprimatur of Section 11, Article XIII of the 1987 Constitution that, “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 shall endeavor to provide free medical care to
Paupers.”

Consistent with the wisdom of our Constitution, it is hereby proposed that the government
should establish an Apex Hospital in every region in the Philippines. The unfortunate reality at
present is that medical services are inequitable. Most specialty hospitals are geographically
located in Metro Manila, thus, patients in distant regions have to endure the costly travel and
accommodation to seek their needed medical treatment.

We have seen this problem magnified when the Coronavirus or Covid-19 pandemic hit our
country. Among the many challenges we faced during the course of the pandemic, our fellow
countrymen suffered from the lack of hospital beds, as well as the access of the most vulnerable
to quality healthcare.

Apex Hospitals will not only address problems we face during this pandemic, but also prepare
our nation from future health related emergencies and crises. Apex Hospitals will likewise
address the medical intervention requirements of patients with particular conditions. Specialty
doctors, machineries, and equipment shall be made available to better address the illness of the
patients. These hospitals will ensure accessible, available, and quality healthcare services to
vulnerable people in the far-flung areas of the Philippines.

In view of the foregoing, the immediate passage of this bill is earnestly sought.


HON. DORIS E. MANIQUIZ
2™ District of Zambales


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

19 Congress
First Regular Session

House Bill No, 4474

INTRODUCED BY: HON. DORIS E. MANIQUIZ

ESTABLISHING APEX HOSPITALS IN EVERY REGION OF THE COUNTRY
AND PROVIDING FUNDS THEREFOR

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

SECTION 1. Short Title. — This Act shall be known as the “Apex Hospitals Act.”

SECTION 2. Declaration of Policy. — It is the policy of the State to adopt an integrated and
comprehensive approach to health development which shall make health services available,
accessible and affordable for all. To this end, reforms shall be introduced to the Philippine
health delivery system to achieve universal health care for Filipinos through the upgrading of
facilities that shall transform regional hospitals into functioning apex hospitals and the
establishment of new apex hospitals in strategic areas of the country.

SECTION 3. Definition of Terms. — As used in this Act:

(a) Anatomic and clinical pathology laboratory system — refers to a facility for the diagnosis
of diseases through laboratory testing of blood and other body fluids, tissues, and the
microscopic evaluation of individual cells. The laboratory testing shall cover the following
areas:

1) Anatomic pathology, which includes histopathology, cytopathology, and electron
microscopy; and,

2) Clinical pathology, which includes clinical microbiology, clinical chemistry,
hematology, blood bank, and molecular diagnostics or DNA testing.

(b) Angiogram — refers to a diagnostic procedure that outlines blood vessels, usually arteries,
in various areas in the body to identify narrowing of or blockages in the arteries in the body.


(©) Apex hospital — refers to an end-referral hospital offering specialized services in accordance
with this Act, and is contracted as a stand-alone facility by the Philippine Health Insurance
Corporation (PhilHealth).

(d) Basic emergency care refers to the response to a situation where there is urgently
required medical care and attention, and shalll include procedures required for initial diagnosis,
use of equipment and supplies in sufficiently addressing the emergency situation, considering
the welfare of the patient. It also includes the necessary medical procedures and treatment
administered to a woman in active labor to ensure the safe delivery of the newborn.

(€) Computed tomography (CT) scan — refers to an X-ray image which is produced by applying
tomography, a technique wherein a computer controls the motion of the X-ray source and
detectors, and processes the data to produce the image. The detailed images of internal organs
obtained by this type of sophisticated X-ray device can reveal anatomic details of internal
organs that cannot be seen in conventional X-rays.

(f) Dialysis — refers to the process of removing waste products and excess fluid from the body.
Dialysis is necessary when the kidneys are not able to adequately filter the blood.

(g) Dialysis facility system — refers to a facility that provides treatment for chronic kidney
disease.

(h) High risk pregnancy unit (HRPU) — refers to a unit in the hospital where women with
complications arising from pregnancy are confined, and whose treatment requires constant
supervision or further investigation and assessment. The unit is operated by experts such as
perinatologists, obstetricians and pediatricians, with the assistance of other specialists. It is a
fully equipped obstetric intensive care unit (ICU) that can handle high risk cases including high
risk neonates.

(i) Intensive care unit (ICU) — refers to a hospital unit where patients requiring close
monitoring, continuous attention, and intensive or critical care are confined. An ICU contains
highly technical monitoring devices and equipment with specially trained personnel on critical
care.

(i) Magnetic resonance imaging (MRI) — refers to a procedure that uses a strong magnetic field
and radio waves to capture detailed images of the organs and tissues within the body.

(k) Mammogram — refers to an X-ray test to visualize normal and abnormal structures within
the breasts.

()) Medical specialist ~ refers to a doctor of medicine that practices and has expertise on a
specific branch of medicine.

(m) Neonatal intensive care unit (NICU) ~ refers to a hospital unit containing a variety of
mechanical devices and special equipment for the care and management of premature or
preterm and seriously ill newborn babies. The unit is comprised of neonatologists, pediatric
subspecialists, and nurses who are highly trained in the management of medical and surgical
conditions of the newborn.


(n) Regional government hospital - refers to a hospital operated and maintained, either partially
or wholly, by the national government or by any department, division, board or other agency
thereof.

(0) Rehabilitation care facility system — refers to a hospital facility that provides a specialized
medical care and/or rehabilitation services to injured, sick or disabled patients, which includes
speech therapy and physical rehabilitation.

SECTION 4. Coverage. — This Act shall apply to regional hospitals whose service capacities
are as general hospitals with at least five hundred (500) beds, and which have been identified
by the Department of Health (DOH) to have full potential to operate as apex hospitals based
on the Philippine Health Facility Development Plan (PHFDP). The DOH may establish new
apex hospitals in strategic areas in the country in accordance with the PHFDP, and subject to
the requirements of Sections 5 and 6 hereof.

SECTION 5. Apex Hospital Modernization Program. ~ Within five (5) years from the
effectivity of this Act, all the DOH regional hospitals described in Section 4 shall be upgraded
or established, to have minimum functional capacities of apex hospitals that are at par with
international health care institutions that provide quality medical services. To achieve this goal,
there shall be an Apex Hospital Modernization Program for the establishment, development,
and enhancement of the physical facilities, equipment and instruments, and service delivery of
all the apex hospitals including the following:

(@) Physical Facilities, Equipment, and Instruments. — At the minimum, all apex hospitals
shall operate and maintain the following physical facilities, complete with the necessary
equipment and instruments including:

Ambulatory Surgical Clinic;

Anatomic and Clinical Laboratory;

Blood Statior

Dialysis Facility;

General Intensive Care Unit;

High Risk Pregnancy Unit;

Isolation Facilities;

Neonatal Intensive Care Unit;

‘Nuclear Medicine Facility;

10. Physical Medicine and Rehabilitation Facility;

11. Psychiatry Facility;

12. Radiologic Facilities such as X-Ray, CT Scan, Mammogram,
MRI, ECG, Angiogram, Ultrasound and others;

13. Surgical Facility and Maternity Facility; and

14, Other necessary medical facilities as may be identified by the

DOH

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Alll the facilities enumerated herein shall have competent and trained nurses, therapists,
medical technicians, and other ancillary and support staff.

(b) Service Delivery. — All apex hospitals shall offer the services for all kinds of illnesses,
diseases, injuries or deformities. It shall have certified and eligible medical specialists


to facilitate timely, efficient, affordable, and accessible diagnosis and treatment for the
following areas:

1. Clinic Services

Family Medicine;
Intemal Medicine
Obstetrics and Gynecology;
Pediatrics; and

Surgery.

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2. Basic Emergency Care Services

3. Atleast one medical specialist on any of the following areas, to be determined by
the DOH based on the burden of disease in the region:

Cardiology;
. Neurology;

Oncology;

Pathology;

Pulmonology;

Psychiatry;

Rehabilitation Medicine;

. Urology; and

Other specialists as determined by the DOH.

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(c) Teaching and training hospital. — Within three (3) years from the effectivity of this Act,
all apex hospitals shall be expanded as teaching and training hospitals with accredited
residency training programs for physicians in the four (4) major specialties namely,
Medicine, Pediatrics, Obstetrics and Gynecology, and Surgery.

The secretary of the DOH shall determine the additional positions required for the purpose
in accordance with the revised compensation and position classification system subject to the
evaluation and approval of the Department of Budget and Management and in compliance with
the civil service laws, rules and regulations.

SECTION 6. Inventory and Audit of Hospitals. - An inventory and audit of the physical
facilities, equipment and instruments, as well as the personnel of the regional hospitals, shall
be conducted within one hundred eighty (180) days from the effectivity of this Act, to
determine the present classification of the respective regional hospitals based on their
functional capacity. The result of the inventory and audit shall be the basis of the modernization
plan for each apex hospital. The establishment of apex hospitals shall be prioritized in areas
where they are most needed. The DOH shall conduct an annual inventory and audit of apex
hospitals for their continuous development and to determine the need to establish new ones, in
line with the Apex Hospital Modernization Program.

SECTION 7. Annual Report. — Two (2) years from the effectivity of this Act and every year
thereafter, the DOH shall submit an annual report on the Apex Hospital Modemization
Program to the Congress of the Philippines, through the Committee on Health of the House of
Representatives and the Committee on Health and Demography of the Philippine Senate.


SECTION 8. Appropriations. — The initial amount for the implementation of this Act shall be
charged against the current year’s appropriation of the DOH. Thereafter, the funding of which
shall be included in the annual General Appropriations Act.

SECTION 9. Implementing Rules and Regulations. - The Secretary of the DOH shall issue
the necessary rules and regulations within ninety (90) days after the effectivity of this Act.

SECTION 10. Separability Clause.— If any provision of this Act shall be held unconstitutional
or invalid, the remaining provisions which are not affected thereby shall continue to be in full
force and effect.

SECTION 11. Repealing Clause. — All laws, decrees, executive orders, rules and regulations,
and other issuances, or parts thereof, contrary to or inconsistent with this Act are hereby
modified, amended or repealed accordingly.

SECTION 12. Effectivity. — This Act shall take effect fifteen (15) days after its publication in
the Official Gazette or in a newspaper of general circulation.

Approved,