Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 2308

INTRODUCED BY REP. MAXIMO, JR. Y. DALOG

EXPLANATORY NOTE
Section 11, Article XIII of the 1987 Constitution states:

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.

At present, the availability of quality health care services is concentrated
in large cities particularly the cities within the National Capital Region. The
services available in the provinces on the other hand, are very inadequate.
More often than not most patients from the provinces are referred to higher level
hospitals in the metropolitan area which is usually more than one hundred
kilometers away.

To address this disparity and inequity in the delivery of quality health care
services in the country, this bill seeks to establish apex hospitals in every region
in the country to make available health services to every Filipino within their
region.

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



Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 2308

INTRODUCED BY REP. MAXIMO, JR. Y. DALOG

AN ACT 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. — \t 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.

(c)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 shall
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.

(e) 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.

(j) 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.

(I!) 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:

(a) 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 Station;

. 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.

WONAMAWNA

(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. Clinical Services

. Family Medicine;

. Internal Medicine;

. Obstetrics and Gynecology;
|. Pediatrics; and,

. Surgery.

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2. Basic Emergency Care Services


3. At least 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 Modernization 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. — \f 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,