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

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 4695

Introduced by Representative Ivan Howard A. Guintu

EXPLANATORY NOTE

One of the interventions sought by Republic Act No. 11223 or the Universal Health
Care Act is the reduction of household out-of-pocket payment (OOP). OOP pertains to
expenses that a patient pays directly to the health care provider without a third party. In other
words, it is the amount of money a patient pays for medical expenses that are not covered by

health insurance.

Despite the passage of the Universal Healthcare Act in 2019, OOP remains to be one
of the largest sources of health financing. In 2020, OOP amounted to P400.1 billion or 44.7%
of the Current Health Expenditure (CHE) of the country. It came second to government
schemes and compulsory contributory health care financing schemes which is the largest
source of health financing in the country amounting to P409.39 billion or 45.7% of the CHE.!
Since nearly half of the country’s health expenditures are financed by households, it is
imperative that they are protected from inflated out-of-pocket payments through mechanisms
that mandate transparency in medical expenses and the cost of healthcare.

Thus, this bill seeks to prevent unexpected medical bills and inflated out-of-pocket
expenses by (1) informing patients about actual prices, (2) requiring healthcare providers,
health insurance issuers and self-insured group health plans to provide information about
expected out-of-pocket costs, (3) increasing access to data to make healthcare information more

” https://psa.gov.ph/pnha-press-release/node/165216


transparent and useful to patients, (4) expanding the ability of consumers to choose healthcare
plans, and (5) removing public barriers to price transparency in the healthcare sector.

In view of the foregoing, the passage of this bill is earnestly sough



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

NINETEENTH CONGRESS
First Regular Session

HOUSE BILL No._ 4695

Introduced by Representative Ivan Howard A. Guintu

\N ACT
ENHANCING THE PATIENT’S RIGHT TO MEDICAL EXPENSE
TRANSPARENCY AND PREVENTING UNEXPECTED MEDICAL BILLS, AND
FOR OTHER PURPOSES

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

SECTION 1. Short Title. - This Act shall be known as the “Medical Bill ‘Transparency
Act”.

SEC. 2. Objective. — This Act aims to enhance the ability of patients to choose the
healthcare that is best for them, by allowing them to make fully informed decisions about their
healthcare, and the price and quality of a good or service in advance. It shall also be the
objective of this Act to help prevent surprise billing or patients receiving unexpected bills at
inflated prices.

SEC. 3. Policy. — It shall be the policy of the State to ensure that patients are engaged
with their healthcare decisions and have the information requisite for choosing the healthcare
they want and need. The government shall eliminate unnecessary barriers to price and quality
transparency; to increase the availability of meaningful price and quality information for
Patients; to enhance patients’ control over their own healthcare resources, including health
insurance coverage; and to protect patients from surprise medical bills.

SEC. 4. Informing Patients about Actual Prices. ~ Within sixty (60) days of the date
of this Act, the Secretary of Health shall craft regulations consistent with applicable law, to
require hospitals to publicly post standard charge information, including charges and
information based on negotiated rates and for common or shoppable items and services, in an
easy-to-understand, consumer-friendly, and machine-readable format using consensus-based


data standards that will meaningfully inform patients’ decision making and allow patients to
compare prices across hospitals.

The regulation shall require the posting of standard charge information for services,
supplies, or fees billed by the hospital or provided by employees of the hospital. The regulation
should also require hospitals to regularly update the posted information and establish a
monitoring mechanism for the Secretary to ensure compliance with the posting requirement,
as needed.

The regulation shall also require the detailed itemization of actual medical bills.

SEC. 5. Transparency in Health Insurance Coverage. ~ Within ninety (90) days of
the date of this Act, the Secretaries of Health and Finance shall jointly issue regulations
requiring healthcare providers, health insurance issuers, and self-insured group health plans to
Provide or facilitate access to information about expected out-of-pocket costs for items or
services to patients before they receive care.

The Secretaries of Health and Finance shall, prior to the issuance of the regulation, issue
an advance notice of proposed rulemaking, consistent with applicable law, soliciting comment
on the proposal.

SEC. 6. Barriers to Health Transparency. — Within one hundred and eighty (180) days
from the date of effectivity of this Act, the Secretary of Health, in consultation with the
Department of Trade and Industry, Department of Finance, the Philippine Competition
Commission, and other relevant agencies shall issue a report describing the manners in which
government rules and practice, or the private sector, are impeding healthcare price and quality
transparency for patients, and providing recommendations for eliminating these impediments
in a way that promotes competition.

SEC. 7. Increasing Access to Data to Make Healthcare Information More
Transparent and Useful to Patients. — Within one-hundred and eighty (180) days of the date
of effectivity of this Act, the Secretary of Health, in consultation with relevant agencies, shal]
increase access to claims data from taxpayer-funded healthcare programs, including those of
the Philippine Health Insurance Corporation, for researchers, innovators, providers, and
entrepreneurs, in a manner that is consistent with applicable law and that ensures Patient
privacy and security.

Access to this data shall be provided in a manner that will facilitate the development of
tools that empower patients to be better informed as they make decisions related to healthcare
goods and services. Access to this data shall also be provided in a manner that will enable
researchers and entrepreneurs to locate inefficiencies and opportunities for improvement, such
as patterns of performance of medical procedures that are outside the recommended standards
of care.


As part of this process, the Secretary of Health shall make a list of priority data sets
that, if de-identified, could advance the policies set forth by this Act, and shall report to the
President and to Congress on proposed plans for future release of these priority datasets and on
any barriers to their release.

SEC. 8. Empowering Patients by Enhancing Control over Their Healthcare
Resources. — Within one-hundred and twenty (120) days of the date of this Act, the Secretary
of Finance, to the extent consistent with law, shall issue guidance to expand the ability of
patients to select health insurance plans that cover low-cost preventive care and/or medical care
that helps maintain health status for individuals with chronic conditions.

SEC. 9. Addressing Surprise Medical Billing. — Within one-hundred and twenty (120)
days of the date of this Act, the Secretary of Health shall submit a recommendation to the
President and Congress on measures that can be taken to address surprise medical billing,

SEC. 10. Non-Impairment Clause. — Nothing in this Act shall be construed to impair
or otherwise affect the authority granted by law to an executive department or agency, or the
head thereof; or the functions of the Secretaries of Finance and Budget and Management
relating to budgetary, administrative, or legislative proposals.

Furthermore, this Act shall be implemented consistent with applicable laws and subject
to the availability of appropriations.

SEC. 11. Separability Clause. ~ If any part or provision of this Act is held invalid or
unconstitutional, the remaining parts or provisions not affected shall remain in full force and
effect.

SEC. 12. Repealing Clause. — All laws, decrees, orders, rules and regulations
inconsistent with the provisions of this Act are hereby repealed or modified accordingly.

SEC. 13. Effectivity. — This Act shall take effect fifteen (15) days after its publication
in the Official Gazette or in any newspaper of general circulation.

Approved,