Alvin M. Manalansan, Health Fellow of the Stratbase ADR Institute
The Universal Health Care (UHC) Act, also known as Republic Act 11223, was signed by President Rodrigo Duterte on February 20. Under this landmark legislation, all citizens, including overseas Filipino workers (OFWs), will be automatically enrolled into the National Health Insurance Program (NHIP), either as direct or indirect contributors, who will be eligible and have access to preventive, promotive, curative, rehabilitative and palliative care for medical, dental, mental and emergency health services.
The NHIP is being administered by the Philippine Health Insurance Corporation (PhilHealth), a government corporation attached to the Department of Health (DoH).
One of the objectives of the UHC Act is to realize universal coverage through a systemic approach and clear delineation of roles of key agencies and stakeholders toward a better performance in the health system. This is actually aligned with the DoH’s flagship program and tagline of “Boosting Universal Health Care via FOURmula One Plus.” The Act is foreseen as the cornerstone that will lead all Filipinos to receive the needed health services without causing financial hardship.
The effective implementation of the Act will rely on building adequate infrastructure, such as access to screening, timely and accurate diagnostics, and the presence of a skilled health work force. Moreover, in order to realize a true universal coverage, the health system should reach populations who are less likely to seek or have access to quality health care, such as those who belong to the vulnerable and marginalized groups.
Amid these overwhelming demands for quality and effective health care, the law is also expected to prioritize and facilitate major reforms that will consolidate the existing yet fragmented financial flows, significantly improve the governance and performance of the devolved local health systems, and institutionalize support mechanisms, such as health promotion and health technology assessment.
Health technology, as defined by the World Health Organization (WHO), is the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve the quality of lives. The term health technology assessment (HTA) was first quoted about 30 years ago and was considered as a way of strengthening the evidence-based selection and rational use of health technologies and increase efficiency when introducing and using the technologies in health care.
Under Section 34 of the UHC Act, the HTA process shall be institutionalized as a fair and transparent priority setting mechanism for the development of policies and programs, regulation, and the determination of a range of entitlements such as drugs, medicines, pharmaceutical products, and other devices, procedures and services, that is recommendatory to the DoH and PhilHealth. The HTA will also recommend the development of any benefit package.
In 2013, WHO publications and resolutions indicated that HTA is an important tool to further advance the implementation of UHC in terms of deciding who should be getting which intervention and at what cost. These concepts are linked to people-centered care, essential packages, resource allocation, and quality of health services delivery to get more cost-effective health care.
Commonly conducted by interdisciplinary groups, the HTA uses analytical frameworks, drawing on clinical, epidemiological, health economic and other information and methodologies. It may be applied to interventions, such as including a new medicine into a reimbursement scheme, rolling out public health programs (such as immunization), priority setting in health care, identifying health interventions that produce the greatest health gain and offer value for money, setting prices for medicines and other technologies based on their cost-effectiveness, and formulating clinical guidelines.
Prior to the passage of the UHC Act, the Philippine health sector lacked a formal national program for HTA, although there were efforts to apply its principles, for instance, when the HTA Committee was established by PhilHealth in the 2000s. The initial role then of the Committee was to conduct assessments of drugs, medical and surgical procedures, and other health interventions that became the basis for PhilHealth’s benefit packages, reimbursement policies and accreditation standards for health providers.
Based on the provisions stated in the newly signed UHC Act, a Health Technology Assessment Council (HTAC) will be formed and composed of health experts: namely: (1) public health epidemiologist; (2) health economist; (3) ethicist; (4) citizen’s representative; (5) sociologist or anthropologist; (6) clinical trial or research methods expert; (7) clinical epidemiologist or evidence-based medicine expert; (8) medico-legal expert; and (9) public health expert.
Once the HTAC positions are fully occupied, they are primarily expected to (1) facilitate provision of financing and/or coverage recommendations on health technologies to be financed, (2) oversee and coordinate the HTA process within DoH and PhilHealth and (3) review and assess existing benefit packages. The HTAC is also expected to conduct assessments in accordance with the principles, criteria and procedures that will ensure that its process is transparent, conducted with reasonable promptness, and the results of its deliberations are made public.
Furthermore, subcommittees will also be formed within the Council, mainly divided into: drugs, vaccines, clinical equipment and devices, medical and surgical procedure, preventive and promotive health services, and traditional medicine.
Earlier last month the DoH announced its call for HTAC nominations, ending on February 28. The nominees should have the track record and competencies that will emulate the expectations and objectives of the Act. Upon five years of the HTAC’s establishment and operation, the Council will transition into an independent entity, separate from the DoH, and will then be attached to the Department of Science Technology (DoST). As long as qualified members will still be appointed to be part of the Council, this should not be taken as a challenge but perhaps even as an advantage.
Nevertheless, the success of the law will not only be dependent on HTAs. Like other enacted policies, its proper implementation will surely depend on political support and leadership. The accountability for decision-making should be clearly established, together with the constant source of funding.
Lastly, the Joint Congressional oversight committee on universal health care should regularly exercise their powers to review the implementation of the law. This will entail a systematic evaluation of the performance of the various agencies with respect to their roles and functions with regards to the objectives of the UHC Act. The lead agencies should also take into consideration the various roles of stakeholders (e.g. patient groups and related industries) in achieving the ultimate goal of universal health coverage.
This article was originally published in BusinessWorld.