REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES:
Quezon City, Manila

FIFTEENTH CONGRESS
FIRST REGULAR SESSION

690

COMMITTEE REPORT NO.
Submitted by the Committee on Health on J2 HAR 2911

Re : House Bill No. 4308
Recornmending its approval in substitution of House Bill No. 3560

Sponsors Representatives Alfredo D. Marajion II and Roman T. Romulo

Mr. Speaker:

The Committee on Health to which was referred House Bill No. 3560 introduced by Rep. Roman
T. Romulo, entitled:

AN ACT REQUIRING HEALTHCARE FACILITIES TO PROVIDE A PRICE LIST OF ITS
HEALTHCARE SERVICES INCLUDING INCIDENTAL EXPENSES AND MEDICAL SUPPLIES
THAT CAN BE CHARGED IN THE MEDICAL BILL

has considered the same and recommends that the attached House Bill No4 3.0 Bontitiea:

AN ACT REQUIRING HEALTHCARE FACILITIES TO PROVIDE A PRICE LIST OF THEIR
HEALTHCARE SERVICES INCLUDING INCIDENTAL EXPENSES AND MEDICAL SUPPLIES
THAT CAN BE CHARGED IN THE MEDICAL BILL

be approved in substitution of House Bill No. 3560 with Rep. Roman T. Romulo, Christoper S.
Co, Mary Mitzi M. Cajayon, Rodel Batocabe and Alfredo Garbin Jr. as authors thereof,

Respectfully submitted,

FREDO D. MARANON Ii
irperson
Committee on Health

‘THE HONORABLE SPEAKER
House of Representatives
Quezon City



HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

15 CONGRESS

HOUSE BILLNO.__ 2208

Introduced by Representative Roman T. Romulo

AN ACT
REQUIRING HEALTHCARE FACILITIES TO PROVIDE A PRICE LIST OF THEIR
HEALTHCARE SERVICES INCLUDING INCIDENTAL EXPENSES AND MEDICAL
SUPPLIES THAT CAN BE CHARGED IN THE MEDICAL BILL

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 "Healthcare Services Price
Disclosure Act of 2011.”

SEC, 2. Declaration of Policy - It is the policy of the State to protect and promote the
right to health of the people and instill health consciousness among them. The State
shall enforce a compulsory posting of the price list of healthcare services, including
incidental expenses and medical supplies that can be charged in the medical bill, to
enable the public to obtain accurate and adequate information that would facilitate and
guide them in making a conscious choice of healthcare facility,

SEC. 3. Definition of Terms — For the purposes of this Act, the term:

a. Diagnostic and Laboratory Clinic refers to a health facility for X-ray, CT scans,
blood chemistry exams, histopathology and Immunopathology, hematology, urine
analysis, parasitology and bacteriology test, serology, blood banking, and other
diagnostic examinations that are necessary for the diagnosis and/or treatment of an
illness and injury.

b. Healthcare Services refer to the services for the diagnosis, treatment and
other forms of healthcare of individuals suffering from deformity, disease, illness or
injury, or in need of surgical, obstetrical, medical or nursing care that are offered,
available and provided by the hospitals, ambulatory surgical centers, diagnostic and
laboratory clinics and other medical clinics.


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For purposes of this Act, the term healthcare services shall include dental
services to perform oral examination, cleaning, permanent and temporary filling,
extractions and gum treatments, restoration, replacement or repositioning of teeth, or
alteration of the alveolar or periodontium process of the maxilla and the mandible that
are necessary for the diagnosis and/or treatment of a dental iliness or injury.

c. Healthcare Facilities refer to the hospitals, ambulatory surgical centers,
diagnostic and laboratory clinics, medical clinics and/or facilities which provide
healthcare services, as defined under this Act, whether or not there is an operating
room equipment and installed bassinets or beds for the use of patients in the
management of deformities, diseases, injuries, abnormal physical and mental
conditions, and maternity cases.

d. incidental Expenses refer to the other services provided by the healthcare
facility incidental and in connection with the healthcare services provided such as, but
net limited to, charges for room and amenities, meals, drugs and medicines, and
payments for use of medical equipment and technology.

e. Medical Bill refers to the costs of healthcare services rendered by the
healthcare facility including incidental expenses and medical supplies charged to the
patient

f. Medical Equipment and Technology refer to the equipment designed to aid in
providing healthcare services.

g. Medical Supplies refer to all healthcare materials and articles used for
providing healthcare services and can be charged in the medicat bill.

h. Patient refers to a person seeking admission or who is admitted and has
availed of healthcare services in a healthcare facility.

i. Room and amenities refer to an occupancy room or a ward room where a
patient is admitted for healthcare services, including detailed list of its amenities

SEG. 4. Price List of Healthcare Services and Incidental Expenses including Medical
Supplies Offered and Charged by @ Healthcare Facility - Healthcare facilities shall make
a price list of its healthcare services, incidental expenses and medical supplies that can
be charged in the medical bill, available to any patient, or patient's representative, so
that the patient or patient's representative, may adequately exercise the option to
choose a healthcare facility. The price list shall likewise be easily accessible to the
general public and without need of any further inquiry by posting the pricelist in a
conspicuous place within the premises of the healthcare facility.

‘All medical bills shall list and itemize all healthcare services, incidental expenses
and medical supplies availed or used by the patient with their corresponding prices
charged to the patient.


SEC. 5. Price List of Healthcare Services, Incidental Expenses and Medical Supplies
Binding On Healthcare Facility — The price list of healthcare services, incidental
expenses and medical supplies shall be binding on the healthcare facility upon the
admission of the patient. Any increase in the price of healthcare services, incidental
expenses and medical supplies shall take effect only after proper posting as required in
this Act; Provided, That the increase shall not affect patients admitted prior to posting of
increase in price.

SEC. 6. Penalties - a} Any person who shall violate Section 4 or Section 5 of this Act, or
its implementing rules and regulations shail be subject to an administrative fine of not
less than Five Thousand Pesos (P5,000.00} but not more than Twenty Five Thousand
Pesos (P25,000.00) per instance of violation without prejudice to administrative
‘sanctions such as suspension or cancellation of license to practice profession for a
period not exceeding sixty (60) days.

b) Any juridical person which violates the provisions of this Act shall
be subject to administrative fine of not less than Ten Thousand Pesos (P10,000) nor
more than Fifty Thousand Pesos (P50,000.00) per instance of violation without
prejudice to suspension or revocation of license to operate such healthcare facility for a
period not exceeding sixty (60) days: Provided, That its officers directly responsible for
the violation shall fikewise be subject to administrative fine of not less than Five
Thousand Pesos (P5,000.00) but not more than Twenty Five Thousand Pesos
{(P25,000.00) per instance of violation without prejudice to suspension or revocation of
license to practice profession for a period not exceeding sixty (60) days. Provided,
further, That if the guilty party is an alien, he shail be ipso facto deported after payment
of fine without need of further proceedings.

The Secretary of Health shall have the authority to impose the administrative

fines and sanctions provided herein including suspension or revocation of license to
‘operate such healthcare facility of recommend suspension of license to practice
profession to the Professional Regulation Commission as the case may be for the
violation of this Act.
SEC. 7. implementing Rules and Regulations - Within ninety (90) days from the
effectivity of this Act, the Department of Health, in coordination with the Department of
Interior and Local Government, shall issue the rules and regulations to effectively
implement the provisions of this Act.

SEC. 8. Implementing Agency - The Department of Health shall enforce the provisions
of this Act and its implementing rules and regulations.

SEC. 9. Separability Ciause - If any part of provision of this Act shall be held
unconstitutional or invalid, other provisions hereof that are not affected thereby shall
continue to be in full force and effect.

SEC. 10. Repealing Clause - All other laws, decrees, executive orders, proclamations
and administrative regulations, or parts thereof inconsistent with the provisions of this
Act are hereby repealed or modified accordingly.


SEC. 11. Effectivity Clause - This Act shall take effect fifteen (15) days after its
publication in any newspaper of generat circulation,

aene

Approved,


FACT SHEET

House Bill No.
(In substitution of HB No. 3560}
(As approved by the Committee on Heaith on January 26, 2011)

AN ACT
REQUIRING HEALTHCARE FACILITIES TO PROVIDE A PRICE
LIST OF THEIR HEATHCARE SERVICES INCLUDING
INCIDENTAL EXPENSES AND MEDICAL SUPPLIES THAT CAN
BE CHARGED IN THE MEDICAL BILL

Introduced by: REP, ROMULO T. ROMAN

Committee Referral: COMMITTEE ON HEALTH (Primary)
Committee Chairperson: REP. ALFREDO D. MARANON iit

OBJECTIVE:

* To enable the public to obtain accurate and adequate information that
would facilitate and guide them in making conscious choice of healthcare
facility.

KEY PROVISIONS:

* Mandates the healthcare facilities to make a price list available to any
patient or representative on its healthcare services, incidental expenses
and medical supplies that can be charged in the medical bill

» Requires the posting of said price list in a conspicuous place within the
premises of the healthcare facilities

« Stipulates that price list shall be binding on the healthcare facitity upon
admission of the patient and that any increase in the price shalt take effect
only after proper posting

+ Penalizes the violator with a fine per instance of violation without prejudice
to administrative sanctions such as suspension or cancellation of license
ta practice profession or revocation of license to operate in case the
violator is a juridical person

« Authorizes the Secretary of Health to impose the administrative fines and
sanctions including the suspension or revocation of license to operate the
healthcare facility.

RELATED LAW:

Section 15, Article II of the 1987 Constitution


Republic of the Philippines
HOUSE OF REPRESENTATIVES,
Quezon City, Metro Manila
18” CONGRESS

House BILL No. 3560

Introduced by Representative Roman T. Romulo
Lone District of Pasig City

EXPLANATORY NOTE

This proposed bill seeks to provide for transparent, accessible and reliable
information on the prices of healthcare services, including incidental expenses
and all items that can be found in the medical bill of a patient by requiring
healthcare facilities to provide a price list of the said services and items.

Health is a basic human right as provided for in Section 15, Article 2 of the
1987 Philippine Constitution, which states:

“The State shall protect and promote the right to health of the people and
instill health consciousness among them.”

Given the high costs of availing healthcare services and due lo lack of
information, most of the public opts lo do home medication. This happens without
them knowing that there are quality services and yet reasonable charges being
hnposed by some healthcare faciliies. If the prices of these services are readily
accessible to the public, it would encourage them to at least compare, assess
and consider getting professioiwal medication and care.

Knowing the prices in advance would also enable the public to make an
intelligent estimate of the medical hills that they would incur once they get
admilled and avoid surprises of the huge amount they have to pay once the
patient bills out

‘Through the passage of this Bill, the public is empowered to choose the
healthcare facility where they would avail medical services especially during
times of economic downtum and ultimately, achieve the national goal of
establishing a responsible and efficient healthcare delivery.

For these reasons, the passage of this bill is eamestly sought

BR 24

HON. ROMAN T. ROMULO:


29

HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

15" CONGRESS
HOUSE BILL NO._3560_

Introduced by Representative Roman T. Romuto
Lone District of Pasig Gity

AN ACT REQUIRING HEALTHCARE FACILITIES TO PROVIDE A PRICE LIST
OF ITS HEALTHCARE SERVICES INCLUDING INCIDENTAL EXPENSES
AND MEDICAL SUPPLIES THAT CAN BE CHARGED IN THE MEDICAL BILL

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

Section 1. Short Title - This Act shalt be known as the “Healthcare Services
Price Disclosure Act."

Section 2. Deciaration of Policy - It is the policy of the State to protect and
promote the right to health of the people and instill health consciousness among
them. The State shall enforce a compulsory posting of the price list of healthcare
services, including incidental expenses and medical supplies that can be charged
in the medicat bill, to enable the public oblain accurate and adequate information
that would facilitate and guide him in making a conscious choice of healthcare
facility

Section 3. Definition of Terms — For the purposes of this Act, the term

3.4 "Diagnostic And Laboratory Clinics” means a health facilily for X-ray.
CT scans, blood chemistry exams, histopathology and immunopathology.
hematology, urine analysis, parasitology and bacteriology test, serology, blood
banking, and other diagnostic examinations that are necessary for the diagnosis
and/or'treatment of an illness and injury.

3.2 “Healthcare Services” means the services for the diagnosis, treatment
and other forms of healthcare of individuals suffering from deformity, disease,
illness or injury, or in need of surgical, obstetrical, medical or nursing care that
are offered, available and provided by the hospitals, ambulatory surgical centers,
diagnostic and laboratery clinics and other medical clinics.

For the purposes of this Act, the term healthcare services shail inciude
dental services to perform oral examinalion, cleaning, permanent and temporary
filing, extractions and.gum treatments, restoration, replacement or repositioning
of teeth, of alteration of the alveolar or periodontium process of the maxilla and
the mandible that are necessary for the diagnosis and/or treatment of a dental
illness or injury

3.3 “Healthcare Facilities” means the hospitals, ambulatory surgical
centers, diagnostic and laboratory clinics, medical clinics and/or facilities which
provide healihcare services, as defined under this Act, whether of not there is an


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40"

H.B. No. 3560 -2-

operating room equipment and installed bussinels or beds for the
r u i
in the management of deformities, diseases, injuties, abnormal ‘physical ‘and

mental conditions, and matemity cases.

3.4 “incidental expenses” means other. servi
‘ices provided by
healthcare facility incidental and in connection with the heatthcare setvions
provided such as, but not limited to, charges for room and amenities, meals

drugs and medicines, and payments for use of i ir
technology medical equipment and

3.5 “Medical Bi” means costs of healthcare services rendered by the

healthcare facility including incidental expenses and medical supplies charged to
the patient.

3.6 “Medical Equipment and Tochnology” means the equipment d
to aid in providing healthcare services. pment designed

3.7 “Medical Supplies” means all healthcare materials and articles used
for providing healthcare services and can be charged in the medical bill

3.8 *Pationt” means a person seeking admission or who is admitted and
availed of heaithcare services in a healthcare facility,

3.9 “Room and amenities” means an occupancy room or a ward room
where a patient is admitted for healthcare services, including detailed list of its
amenities.

Section 4. Price List of Healthcare Services and Incidental Expenses Including
Medical Supplies Offered and Charged by a Healthcare Facility - Healthcare
Facilities shall make a price list of ts healthcare services, incidental expenses
and medical supplies that can be charged in the medical bill, available to any
patient, or patient's representative, so that the patient or patient's representative,
may adequately exercise the option lo choose a healthcare facility. The price list
shall likewise be easily accessible to the general public and without need of any
further inquiry by posting the pricelist in conspicuous place within the premises
of the heaitheare facility.

Ail medical bills shall list and itemize all healthcare services, incidental expenses
and medical supplies availed or used by the patient with their corresponding
prices charged to the patient.

Any violation of the provisions of this Act shall be unlawful,

Section 5. Penalties - a) Any person who shall violate the provisions of this Act,
or its implementing rules and regulations shall be subject to a fine of not less
than Five Thousand pesos (P5,000.00) but not more Ihan Twenly Five thousand
pesos (P25,000.00) per instance of violation without prejudice to administrative
sanctions such as suspension or cancellation of license to practice profession.
‘Any juridical person which violates the provisions of this Act shall suffer the
penalty of a fine of not less than ten thousand pesos (P10,000) nor more than
fifty thousand pesos (P50,000.00) per instance of violation and suspension or
revocation of license to operate such heallhcare facility, Provided, that its officers
Uirectly responsible for the violation shall suffer the penalty of fine of not less
than Five Thousand pesos (5,000.00) but net more than Twenty Five thousand
pesos (P25,000.00) per instance of violation and suspension or revocation of
license to practice profession, if applicable, and by imprisonment of not tess than
six (6) months nor more than one (1) year or both fine and imprisonment at the


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b} A second violation under this paragraph shail also carry with it the penally of
revocation of license to operate.

Section 6. Implementing Rules and Regutations - Within ninety (90) days from
the effectivity of this Act, the Department of Health, in coordination with the
Department of Interior and Local Goverment, shall Promuigate the rules and
regulations to effectively implement the Provisions of this Act.

Section 7. implementing Agency - The Department of Health shall enforce the
Provisions of this Act and its implementing rules and regulations.

Section 8. Separability Clause - f any part or provision of this Act shall be held
unconstitutional or invalid, other provisions hereof that are not affected thereby
shall continue to be in full force and effect.

Section 9. Repealing Clause ~ All other laws, decrees, executive orders,
proclamalions and administrative regulations, or parts thereof inconsistent
herewith are hereby repealed or modified accordingly.

Section 10. Efectivity Clause - This Act shail take effect fifteen (15) days after its
publication in at least two {2) national newspapers of general circulation,

Approved.


Republic of the Philippines
HOUSE OF REPRESENTATIVES
COMMITTEE ON HEALTH
Quezon City, Metro Manila

MINUTES OF MEETING OF THE COMMITTEE ON HEALTH HELD ON JANUARY
26, 2011 AT 9:00 AM, CONFERENCE ROOMS 9 AND 10 OF THE RAMON V.
MITRA BLDG, HOUSE OF REPRESENTATIVES, BATASAN, QUEZON CITY.

AUTHORS PRESENT:

1. Hon. Roman Romulo House Bilt No. 3560
2. Hon. Mary Mitzi Cajayon House Bill No. 367
3. Hon. Susan Yap House Bill No, 937
4. Hon Rufus Rodriquez House Bill No, 1566
5. Hon. Maximo Rodriguez, Jr. -same—

6. Hon. John Victor Ejercito House Bill No. 2547
7. Hon. Loreto Leo Ocampos House Bill No, 3921
8. Hon. Bemadette Herrera-Dy House Bill No. 1083

GUESTS/RESOURCE PERSONS IN ATTENDANCE:

4. Mr. Oscar Abadu Jr. OIC Senior Manager, Marketing and Collection,
Philhealth

2. Ms. Nerissa Santiago Vice President for Actuary, Philhealth

3. Dr. Israel Pargas Senior Manager, Philheaith

4. Prof. Emmanuel Leyco Asian Institute of Management

5. Dr. Larry Cedro Department Manager, Philippine Chanty

‘Sweepstakes Office (PCSO)

6. Dr. Bu Castro Commission on Legislation, Philippine Medical
Association (PMA),
Philippine Hospital Association (PHA)

7. Dr. Rustico Jimenez. President, Private Hospitals Association of the
Philippines (PrHAP)

8, Dr. Gerardo Bayugo Assi. Secretary, Department of Health (DOH)

9. Atty. Alecon Gloria-Rubio Legal Officer, Phifippine Amusement and Gaming
‘Corporation (PAGCOR)

40. Dr, Reinelda Raffinian — Division Chief, Department of Interior and Local
Goverment (DILG)

14. Ms, Rhodora Alday — Department of Social Welfare and Development

(OSWD), NHTSPR

|. CALL TO ORDER! ROLL CALL

Rep. Affredo D. Marafion Il, Chairperson of the Committes on Health. called the .
meeting to order at 9:25 p.m. Upon motion of Rep. Roman Romuto, duly seconded’
and there being no objection, the calling of the roll was dispensed with.


Il, APPROVAL OF THE MINUTES.

Upon mation of Rep. Mary Mitzi Cajayon, duly seconded by Rep. Imelda Calixto-
Rubiano and there being no abjection, the minutes of Navember 10 and December 14,
2010 meetings were approved

Ml, PRELIMINARY REMARKS OF THE CHAIRPERSON

The Chair informed the Members and resource persons that the meeting is the start of
a series of meetings to deliberate on the 35 amendatory measures to Republic Act No.
7875, better known as the National Health Insurance Act. With the commitment of the
‘Aquino administration to push for the mandatory universal healthcare coverage for all
Filipinos as deciared during the State of the Nation Addrass (SONA), the Chair said
that it is high time to revisit the present law and ensure that its provisions are
responsive 10 present-day realities. The Chair also stated that it is imperative that the
Phithealth Corporation, as the implementing agency, be strengthened te enable it to
deliver healthcare benefits and to ensure the viability of the program in partnership
with the Department of Health. The Chair then thanked the Members and the resource
persons for their presence.

IV. APPROVAL OF THE DRAFT COMMITTEE REPORTS ON THE FOLLOWING
MEASURES:

1, House Bill No. 3660 entilled, AN ACT CONVERTING THE NORTHERN SAMAR
PROVINCIAL HOSPITAL IN CATARMAN, NORTHERN SAMAR, INTO SAMAR
ISLAND MEDICAL CENTER UNDER THE SUPERVISION, CONTROL AND
MANAGEMENT OF THE DEPARTMENT OF HEALTH, introduced by Rep. Raul
R. Daza;

2 House Bill No. 3088 entitied, AN ACT TO PROMOTE AND SUPPORT
BREASTFEEDING AS AN ESSENTIAL COMPONENT OF FAMILY PLANNING
AND RESPONSIBLE PARENTHOOD AND FOR OTHER PURPOSES,
INTRODUCED BY Rep. Anna York P. Bondos, and

3, House Bill No, 590 entitled, AN ACT ESTABLISHING A PROGRAM FOR
PUBLIC EDUCATION ON PROSTATE CANCER, introduced by Reps. Rufus B.
Rodriguez, Maximo B, Rodriguez Jr., and Augusto Boboy Syjuco

Upon motion of Rep. Cajayon, duly seconded by Rep. Calixto-Rubiano and there
being no objection, the above stated draft Committee Reports were approved.

V. DELIBERATION ON HB NO. 3560, Re: REQUIRING HEALTHCARE FACILITIES
TO PROVIDE A PRICE LIST OF ITS HEALTHCARE SERVICES AND OTHER
EXPENSES THAT CAN BE CHARGED IN THE MEDICAL BILL

Rep. Roman Romulo, principal author of Hi No. 9560, explained that his proposal
seeks 10 require healthcare facies to have the price list of diagnostic procedures
Services and.supplies posted at conspicuus areas in the health facility for the
awareness of the citizens. He added that his bill seeks to provide the citizenry with a
full disclosure of all healthcare services as well as medicines and supplies being
. provided for by the healthcare faciliies for purposes of transparency Considering that
ve bit is a non-contfoversial measure, he urged the Body to approve his proposal.



‘As a reaction to the proposed measure, Dr. Bu Castro, representing the Philippine
Medical Association (PMA) and Philippine Hospitals Association (PHA), lauded the
noble intents of HE No. 2560. He however suggested that they be given leeway in the
posting of the prices of nealthcare services because some complications may occur
that would affect the cost of services of a particular confinement, For his part, Dr.
Rustico Jimenez, President of the Private Hospitals Association of the Philippines
(PrHAP), echoed the statement of Dr. Castro that there must be a raom for flexibility so
as to protect the doctors and the hospitals against possible suits should they fail to
protect the wetfare of the patient.

__ Dr, Israel Pargas of Philhealth informed the Bady thal as part of the Corporation's
accreditation requisites, the hospitals are required to post the cost of services,
medicines, laboratory and diagnostic procedures. However, he clarified that said
requirement does not cover professional fees of doctors. Reacting to this, Rep.
Romulo informed Dr. Pargas that there is a Philhealth accredited hospital in his district
which dogs not have any posting at al.

‘AM this juncture, Rep. Loreto Leo Ocampos inquired whether the Department of Trade
‘and Industry (DTI) has a representative in the meeting considering that said
Department has something to do with the cegulation on the prices of medicines. In
response, Rep. Romulo explained that his bill does not intend to control the prices of
hospitals or penalize the same but rather requires transparency on the part of the
hospitals relative to the prices of their services. Sharing her own observation on the
matter, Rep. Cajayon averred that indeed, there are hospitals that are really comptying
with the posting requirement. But, at the bottom of the price list, a phrase “subject to
change without prior notice” can atso be found. She then asked the proponent of the
possible remedy to this condition that hospitals can easily change their prices without
prior notice. In response, Rep. Romulo said that at the most appropriate and
Immediate time, hospitals must do away with such warming which serves as their
safety net.

Responding to the query of Rep. Ocampos on the penalty for violations of this
Tequiremeni, the author specifically cited Section 5, the penal clause of the bi, where
there are corresponding administrative sanctions, fines ang penalty for violators

At this point, Dr. Pargas informed the Body that Philneaith has actually increased its
benefits to members. However, he explained that immediately afler said increase, the
hospitals and healthcare providers also increased the prices of their services <o that
the increase in benefits given by Philheatth was not feit by its members. He then
expressed the same observation made by Rep. Cajayon.

At this juncture, Rep. Herminia Roman called the attention of Dr. Pargas and informed
fim of the common practice of some doctors who overcharge private patients afler
knowing that thay are Philhealth members. In response, Dr. Pargas admitted that ney
ate aware of the fact that some doctors are really charging excessive amounts for
Services given especially to private patients. He clarified though that the Corporation
feimburses up to the allowable limit set by Philhealth only and that the excess in the
hospital bill will have to be shouldered by the patient. But for ward type of
‘accommodation, Dr. Pargas made clear that doctors are not allowed to charge beyond
the amount set by Philhealth.

Having heard all the views on the subject, Rep. campos moved for the approval of
tha bil whien was duly seconded by Rep. Cajayon. There being no objection. House
Bil No. 3560 was approved subject to the amendment proposed by Rep. Cajayon.


The chair then instructed the Committee Secretary to prepare the corresponding
Committee Report. pep . $

VL DELIBERATION ON HB NOS. 367, 937, 1566, 2547, 3921 AND 1083,
Re: MANDATORY UNIVERSAL HEALTHCARE COVERAGE BILLS

Rep. Cajayon, principal author of House Bill No. 387, underscored the particular
provision in her bill which provides that premium payment for the indigent families shail
be fully subsidized by the national govemment based on the Poverty incidence set by

_ the National Statistics Coordination Board (NSCB). She said that at times, quality
heatthcare for the public was severely affected because the politicians were the ones
deciding who the beneficiaries of Philhealth should be. She stressed that providing
mandatory universal healthcare coverage bill for all Filipinos is one of the most
effective ways of bridging the inequity in the healthcare system that is prevailing in
Philippine society. She expressed the view that bridging the inequity in the provision of
healthcare can only be realized if the required premium payment will be fuily
subsidized by the national government.

Rep. Herrera-Dy, principal author of House Bill No. 1083, explained the merits of her
proposal. She said that it intends to amend several laws such as Republic Act 7875 or
the National Health Insurance Act, Republic Act 7392 of the Midwifery Act and
Republic Act 7600 or the Rooming-In Act. She averted that healthcare services should
be made universally applicable to ail people regardiess of thsir economic and social
status, She added that it is imperative upon the government to focus on providing
holistic healthcare, giving emphasis on health promotion and disease prevention.
Finally, she stressed that the passage of the universal healthcare bills will result in
affordable quality healthcare, She then urged the Committee for the immediate
passage of her proposal.

Dr. Gerardo Bayugo, Assistam Secretary of the Department of Health, reported that
one of the goals of the Department is to have available resources for the healthcare of
all Filipinos. He cited particularly the improvement of the health of the mothers,
especially the child-bearing mothers, as among their paramount concems. Dr. Pargas
for his part said that Philneaith offers newbom care under the essential newbom care
package. As to the other concems of House Bill No. 1083, Dr. Pargas promised to
submit the Corporation's position on the matter.

Regarding Malacafang's pronouncement prioritizing the passage of a mandatory
universal healthcare coverage, Rep. Nograles asked Dr. Pargas whether or not the
Palace has given concrete instruction to Philhealth on the matter. He also asked
whether or not the amendatory bills jive with the administrations healthcare programs.
Dr. Pargas informed the Body that the DOH, Philheaith, DSWD, OSM and DOF are
currently discussing the universal healthcare policy of the Aquino administration. He
said that there was an Administrative Order that came out identifying the
‘administration's health agenda. On the other hand, Dr. Bayugo explained that
universal healincare proposal is the main strategy of Secretary Enrique Ona of the
Department of Health (OOH) in reforming the healthcare system that focuses on three
aspects, namely: 1, universal coverage for healthcare insurance, 2 providing
assistance to enhance health facilities, and 3. addressing the Millenium evelopment
Goals of providing better heatth for mothers and chikiren and controlling emerging and
‘common infectious diseases, He atided that the proposal pushing for Phiheatth
mandatory universal healthcare coverage is very much in line with the thrust of the
administration.

A


Should the proposal become a law, Rep. Nograles inquired as to the role played by the
legislators in identifying potential Philhealth beneficiaries using the Prority
Development Assistance Fund (PDAF). Dr. Bayugo explained that the formal sector
consisting of private and public employees are already covered by Philhealth by virtue
of their employment, The indigents are also being cavered by spansored programs. It
is the poor members of the informal sector that are left out. Dr. Bayugo pointed out
that this particular group can now be the target of support by the legislators, LGUs and
private individuals.

Ms. Rhodora Alday of the DSWD reported to the Body that they are ciosely working
with the DOH and Phitheatth in identifying who among the poor households identified
by the National Household Targeting System for Poverty Reduction (NHTS-PR) are
already covered by health insurance. Corollary to this information given by the DSWD
representative, Rep, Cajayon inquired whether or nol DSWD is coordinating with the
LGUs and congressmen in identifying the poorest of the poor. Rep. Cajayon further
pointed out that legistators are not being consulted in the identification of the target
beneficiaries, In response, Ms, Alday claims that all their field activities are coordinated
with the LGUs, Reps. Cerafica and Herrera-Dy shared the sentiment of Rep. Cajayon
in that the identification of the beneficianes should be coordinated with the District
Representatives and not only with the LGUs. Reacting to the comments made by
Reps. Cajayon, Cerifica and Herrera Dy, Rep. Roman suggested to the DSWD not to
pass through the LGUs anymore and instead, coordinate directly with the social
‘workers in the area.

At this point, the Chair inquired whether or not the budget for universal Philiealth
‘coverage is partly included in the budget given to the DSWD for the Conditional Cash
Transfer (CCT) which amounted to P216. Ms. Aiday answered in the negative. The
Chair also inquired if the DSWD list for universal Philheaith coverage the same as the
list being used in identifying the poor beneficiaries under the CCT program. Ms. Alday
said that for the Pantawid Pamilya Pitipina Program (4 Ps), they are using the fst of
the NHTS.

‘At this point, Rep. Rufus Rodnguez, author of House Bill No. 1566, said that if
Congress has increased the DSWD budget and solidly supported the CCT program.
the move for mandatory universal healthcare coverage must also be supported
considering that there are § milion poor Filipinos that are not yet covered by
Philhealth, He then asked the Philhealth representative to confirm the accuracy of the
figure he cited. Responding to the query, Mr, Abadu, Philhealth Senior Manager, said
that under the LGU identified list, there are 66 million families not yet covered by
Philhealth compared to 9.3 million under the NHTS list of which 4.7 million are
identified as poor. . He said that based on the current data, only 20% or around
870,000 poor families that are curently enrolled as identified by the LGUs matched *
with the NHTS list of the DSWD. Surprised with the conflicting figures, Rep. Rodaguez
inquired on the steps being undertaken to reconcile the data, adding that the 5 million
poor families in his bill was based on the actual pronouncement of Philhalth. Mr.
(tbadu said that their proposal is for the NHTS list as identified by the DSWD to be fully
subsidized by the national government and for the Community-Gased Monitoring
System (CBMS) list identified by the LGUs to be partially subsidized by either the
legislators and the LGUs. Rep. Rodriguez also asked whether or not the F billion as
provided for in House Bill No. 1566 would be enough to attain full Phithealth coverage
of poor Filipinos. Mr. Abadu answered in the affirmative.

LAt this juncture, Rep Rodriguez directed Mr. Abadu to submit in the next hearing the
data regarding the conflicting figures between the list of OSWD and LGUs for purposes
of proper computation of the actual amount needed for universal healthcare coverage.


‘The Chair then requested Philhealth to submit a reconciled list classified into a per
district basis. Mr. Abadu promised to comply with such request.

Still on the listing issue, Rep. Romeo Acop narrated that during the last budget
hearing, no fess than the Secretary of the DOH, when asked about the $40 million
grant for healthcare coverage, admitted that they are having a problem reconciling the
Gifferent lists of the DWSD and LGUs. Mr. Abadu explained that such grant was
specifically intended for the NHTS list which can cover 1.8 miltion poor families. Rep.
Acop asked the reason for having two sets of list. Mr. Abadu clarified that dunng the
last administration, the adoption of the NHTS was particularly intended for the poverty
alleviation program of the national government and that the identification process
under NHTS may not be the same with that of the LGUs. Rep. Acop asked which
among the two lists will prevail. Mr. Abadu said that Philhealth can use both, with the
NHTS list being fully subsidized by the national government and the LGUs list on a
partial subsidy scheme. .

‘On the assets of Philhealth, Rep. Acop inquired whether or not there is truth to the
report that the Corporation has a tatal of P110 billion in its coffers. Ms. Necisa
Santiago, Philhealth's Vice President for Acluary, reported that as of November 2010,
the Corporation has a total assets of around P1085 billion which consisted of around
P97 billion investments in goverment securities and about P6 billion liabilities as
accounts payable of the Corporation. Responding to the query of Rep. Acop, Ms.
Samiago admitied that Philhealth is eaming. This admission prompted Rep. Acop to
‘state that there might be no need for the P9 billion subsidy as provided for in House
Bill No. 1566, Ms. Santiago clarified to the Body that the mandate af the Corporation
is to use the funds for the benefit payments of the members. At this point, Rep. Acop
informed the Body that he has filed a resolution calling for an inquiry into the P110
billion assets of Philheaith.

Rep. Randolph Ting inquired on the total membership for universal Philheakh
coverage in the entire country, taking info account those children that are fisted as
dependents of their parents. Mr. Abadu explained that technically, universal coverage
means 85% coverage out of the estimated 94 million Filpinos. He said that with the 22
mnilion registered members of Philheatth, their estimate is that 85% of the population
gre already covered. He admitted that they are having some problems with the
Gotimated number of dependents per member because of the multipliers being used.
Se to the ideal number of families to be enrolled, the estimate is around 25 million
families, he said, Rep. Ting expressed doubt over the 25 million families estimated
target, pointing f0 the earfer statement of Mr. Abadu that 22 million enrollees already
represent 85% coverage. He then suggested to Philhealth to review its own statistics
inorder to come up with a reat number that needs to be enrolled, taking into account
those children below 18 years old wha are dependents of their parents and the senior
citizens who are dependents of their working children.

At this jincture, Rep. Lani Mercado-Revila inquired from Rep. Rufus Rodriguez, ‘he
source of PS billion appropriations he cited under House Bill No. 1566. Rep. Rufus
Rodriguez explained that such amount was based from the statement of the President
Gurng the SONA where it was cited that P9 billion was nreedad to enroll 6 milion poet
Filipino families. Upon clarification by the Chair, Mr. Abadi admitted that at 1,200.00
Snnual premium per family, only PS billion is actualy needed to cover 5 million families
‘and that with P9 billion, bath list from NHTS and LGUs can be covered.

* Feep. Maximo Rodriguez Jr. at this point inquired regarding Philnealn's palcy, of giving
premium discounts for calamity stricken areas. Mr. Abadu ‘explained that for 2008 until
POTD there was 50% discount on premium being given to LGUs with national


goverment counterpart. However for 2011, being a transition year in adopting the
NHTS list, he said that the Corporation is having difficulty giving the same discount
wilhout the national government counterpart. He however clarified that in the next
Philhealth Board meeting, the issue an premium discounts will be seitied. Rep. Rufus
Rodriguez for his part inquired why he was billed a non-discounted rate for the
premium of his constituents that were victims of calamity considering the fact that his
request for such discount had been approved. He then suggested to Mr. Abadu that
other flood stricken areas of Mindanao be aiso considered in the Philhealth Board
meeting. Mr. Abadu promised to include the same in the Board's agenda.

‘At this juncture, Rep. Ting inquired regarding the breakdown of the 22 million
Philhealth enrollees. Mr. Abadu gave the breakdown as follows: 3.7 million self
employed, 2.3 million overseas workers, 7.8 million private sector employees, 1.9
million government employees, 6 million sponsored members and around half million
retirees who are lifeime members. Mr, Abadu assured Rep. Ting that the full report on
the matter will be submitted next hearing.

Rep. Anthony Golez inquired whether or not the 6 million poorest of the poor are really
warm bodies, saying that in his district, none of those who live in the slum area would
say that they are members of Philhealth. He also asked whether or not Philhealth has
already identified the informal sector considering that the working sector both in private
and public, OFW, retirees and those under the sponsored program have already been
identified, Mr. Abadu explained that under the present set up, the national gaverament
subsidy can only be accessed by Philheatth once the LGUs or the sponsors will be
able to identify their indigent families, adding that the law mandates the LGUs to
identify who should be included in the list. Given the situation, Rep. Golez was
surprised why some Mayors in his district are still complaining because Phihealth is
not giving cards to the already identified poorest of the poor. Hs asked why the LGUs
have to spend for the premium considering thal Phithealth has the obligation for it
Rep. Golez also asked why in the present sat up, the DSWD is the one identifying the
poorest of the poor. Mr. Abadu clarified that originally, the national government has no
role in identifying the poorest of the poor and that it is the LGUs who are actually
mandated by law to do so. The DSWD came in only when the NHTS was introduced,
he added. Rep. Golez averted that there is now duplication of functions where the
legislators are using their PDAF to subsidize the poor while the national govemment is
doing the same thing. He stressed that PDAF could be used for other purposes
instead.

Regarding the socialized payment of premium, Rep. Goiez wondered why a member
of the informal sector who could be super rich is paying only P1,200.00 annually
which ts Just exactly the same wilh the premium being paid by an ordinary Filipino, He
opined that rich members may not mind even if they pay as high as 20,000.00 a year
because it can be part of their social obligation to the country. He said that the top 10%
of such sector may be able to subsidize the needed amount and that the govemment
might not even have to shel out money. He then asked whether or not Phithealth has
an actuarial study on the matter. Mr. Abadu informed the Body that since last October
2010, Philhealth has been collecting a minimum amount of P200.00 on a monthty
basis from the professionals and that the Corporation intends to increase this amount
to P300.00 per month. Rep. Golez then suggested that Philheafth snould conduct a
national survey to determine up to how much the professionals and the rich people
Under the informal sector would be willing to pay as premium contAbution to their
membership

On tne benefit payments, Rep. Golez inquired regarding the percentage that Philhealth
is paying to private and government hospitals, saying thal based on this, i couk! be


determined whether or not the poorest of the poor, evan if they are already covered by

Phitheaith, can afford to go to a hospital. Mr. Pargas promised to submit the data
regarding the matter.

At this juncture, Rep. John Victor Ejercito, author of House Bill No. 2647, explaines the
merits of his proposal. He said that the government's lack of focus on the health sector
is evident as the total budget for health only accounted for less than 3% of the national
budget. He said that the National Heaith insurance Act failed to fulfil its mission. Thus,
his bill seeks to provide mandatory universal healthcare to every Filipino citizen by
their immediate and automatic inclusion to Philhealth.

For House Bill No. 937, Rep. Susan Yap, author of the proposal, stated that because
of government's lack of prioritization of the health sector, the government falls shost of
its objective to provide universal quality healthcare. However, with the current
administration's advocacy for universal healthcare coverage for all Filipinos specially
the indigents, she expressed optimism that the long time. problem of inability of the
government to provide healthcare for all can now be addressed with the passage of
House Bili No. $37 along with the other similar proposals.

At this juncture, Rep. Eleanor Bulut-Begtang brought to the attention of the Body the
current situation in her district im the Province of Apayao where her constituents could
not maximize the use of Philhealth’s benefits because they have to buy the medicines
outside of the hospital. She alsa aired the problem regarding the list of the DSWD
where the LGUs are not being consulted. On this, Dr. Pargas acknowledged that such
Situation I a perennial problem especially in goverment hospitals where there is
usually lack of supplies and medicines. However, he pointed out that Philhealth is
Soing reimbursements for the purchases of medicines outside the hospital. Corollary
to this, Rep. Maximo Rodriguez Jr. inquired how the capitation fund is being utilized,
saying that one of the purposes of capitalion fund is to assist in providing medicines 19
patients. In response, Dr. Pargas explained that such fund is being paid back to tle
LGUs to be given to authonzed hospitals and Rural Heatth Units (RHUs) to provide
drugs and medicines far indigent members. He said that the policy right now is to
Gliceate a minimum of 40% of the capitation fund for drugs and medicines. Rep. M
Rodriguez then suggested that 50% of the capitation fund be allocated for medicines.
Dr, Pargas expressed no objaction to the suggestion of Rep. Maximo Rodriguez, J.

At this juncture, Rep. Peter Unabia said that there is a-need to organize a separate
Body to review the list under the NHTS because there are personalities in his distct
that are. not indigents but were included under the NHTS fist. Responding to this. Ms.

Aiday said that they have already organized Commitlees. at the local level to receive,
resolve complaints and to validate and verify if indeed the poorest of the poor in the
municipality have been identified. In relation to this, Rep. Jose Aquino i! inquired a 1°
Row long if would take before an unqualified person could be taken out fom the NHITS
fit To this query, Ms. Alday said that if takes @ maximum of thity (30) days to
ierrect the mistake because the household being complained of will have to be
revisited and there will be re-assessment following certain protocols.

Concemed about the financial viability and projected Ife of the Corporation that might
soneeiieed due to uncollected premiums, Rep. Philip Pichay asked how much the
pe onal govemment owes Philheaith. Accoriing to Mr Abadu. the natiogal
government owes P5.8 billion based on the current billing. On the other hand, Ms.
Santiago clarified that such amount represents only the arrears for tne premium
payments of the indigents and there is fill an accumulated differential on the
premiums of goverment employees: from 2001-2008 in the amount ‘of P9 billion.
Piven the huge amount of uncoRcted premiums from the national government oven


without its obligation yet to subsidize the premiums under the mandatory universal
healthcare coverage, Rep. Pichay expressed his apprehension as to the viability of the
program and the life of the Corporation in the years to come after the passage of
these bills into law.

At this point, the Chair asked for the submission of an actuarial computation based on
the observations of Rep. Pichay

Still on the financial aspect, Dr. Leyco of the Asian Institute of Management said that in
terms of current funding status, Phithealth is *pverly reserved" by around P44 bitlion
based on his study on the subject. He apined that the focus af legislation should not be
on who should be covered because it is already provided for by law but rather, the
universal healthcare shouki be geared in providing appropriate healthcare for
inpatients and outpatients as well. He stressed that the initiative should result into a
more equitable access to healthcare instead of employing more administrative
interventions. ‘The Chair requested Mr. Leyco to submit his position en the matter.

Reacting to the statements made by Prof. Leyco, Ms. Santiago asserted that
Philheatth is not over reserved having paid P26 billion in benefits for 2009 and around
P30 billion in 2010. She added that due to the benefit reforms being undertaken by the
Corporation, they intend to pay double the previous amount in the succeeding years.
Nonetheless, Rep. Acop mainiained that currently, Philheaith is reaily over reserved by
around P44 billion, pointing to the statements of Mr. Leyco which was based on a
‘specific perod in the past as compared to that of Ms. Santiago which, according to
him, is futuristic.

At this juncture, Rep. Pichay inquired on the amount of recelpls in premium of
Philheatth in relation to the total benefit payments. Ms. Santiago said that as of
November 2010, the total premium receipts amounted to P26.4 billion as compared to
the benefit payments of P27 billion. She said that the operating cost of the Corporation
for the same period amounted to P3.4 billion. Rep. Pichay also inquired regarding the
income on maney market placements of Phithealth. Ms. Santiago said that investment
income as of November 2010 is around P5.7 billion. All told, Rep. Pichay concluded
that there is ne such thing as over reserved considering that Phitheaith is almost just
‘on a break even status, He stressed that whatever reserved for now, it is intended for
the future when the premium receipts will be much less than the benefit payments
because more cetirees will be coming in. Rep. Pichay expressed the view that under
such situation, and if the Corparation is still going to increase benefits, Philhealth could
have a negative cash flow. Nonetheless, Rep. Pichay added that if the national
government will pay its obligations to Philheath, the Corporation would not sunt out of
gash. After listening from Ms. Santiago regarding the “no balance scheme", Rep.
Rufus Rodriguez for his part said that probably it is a misconception to say that
Phithealth is over reserved. He inquired whether or not the Corporation intends to
increase its premium within the next two years. In response, Ms. Santiago said that
based on jaw, RA. 7875 as amended, Philheatth is limited to collect only up to a
maximum premium of 3% of the member's salary. She added though that they are
considering to propose some amendments to said law.

Due to the time constraint, the Chair, at this point, requested the representatives of the
DILG. PCSO and PAGCOR to Submit their respective position regarding the
proposals.


‘Vil. ADJOURNMENT

Upon motion duly seconded and there being no objection, the meeting was adjourned
at 12:30 p.m.

I hereby certify to the correctness of the forgoing minutes,

MA. LOURDES M. SANCHEZ
Acting Commitlee Secretary

Corhmittee on Health