Problem Solving the Philippines: The Study I Can’t Find, and the Rules Under the Universal Health Care Act
By Giancarlo Angulo
I CANNOT FIND THE INDEPENDENT STUDY
The Universal Health Care Act ties a big decision to one document. Section 41(d) says that all local health systems are to be integrated, by Executive Order, “upon positive recommendation” of an independent study commissioned by the Joint Congressional Oversight Committee on UHC and of the Health Secretary. I looked for that study and could not find it.
TLDR
- The study is the gate for nationwide integration of local health systems. I found no published copy, no validation studies from NEDA or PSA, and no annual reports to the committee.
- The Act’s implementing rules (the IRR) are about 2.4 times as long as the Act and send many details to later “guidelines”.
- The IRR restates four of the Act’s deadlines as running from its own effectivity, a shift of at least about 7½ months, and adds one qualifier to a benefits rule.
This is part 2 of 4 in The UHC Series. In part 1 I covered what the Act promises and who has to deliver it.
What I looked for, and what I found
I searched the web and news for the study itself, for the committee’s reports, for validation studies by NEDA, PSA or the National Institutes of Health, and for annual DOH and PhilHealth reports submitted to the committee, which Section 39 also requires. I found:
- The committee exists. It held an organizational meeting and a June 2020 session on implementation.
- In 2025 and 2026, senators said they would convene it.
- Think-tank briefs expected an independent evaluation by 2025 or 2026. I found none published.
- A 2026 brief describes integration as still optional for local governments.
What I could not do: search the committees’ own records at the Senate and House directly. If the study exists, it is not easy for an ordinary reader to find, and for a law of this size that is a problem in itself. If you have it, please send it or post the link in the comments.
The DOH made two related promises of its own. Its monitoring order (Administrative Order 2021-0026, March 2021) says an evaluation of UHC “conducted by an independent institution” is to be developed “at the beginning of implementation,” with the results made public, and that a UHC monitoring report is to be produced every year. I searched for both and could not find them either. The DOH website blocked my search, so this is a limit on what I could reach, not proof that they do not exist.
The rules under the Act (the IRR)
The Act told the DOH and PhilHealth to write implementing rules. The Health Secretary signed them on October 10, 2019, about five weeks after the 180-day deadline. I could not find when they were published. The IRR takes effect 15 days after publication, so no earlier than October 25, 2019, against the Act’s own effectivity of about March 8, 2019.
There is a second condition. Under the Administrative Code (Book VII, Sections 3 and 4), agencies must also file their rules with the UP Law Center’s Office of the National Administrative Register (ONAR), and a rule takes effect 15 days from filing unless the law fixes another date. The Supreme Court has held that both publication and filing are required before implementing rules take effect (Philippine Association of Service Exporters v. Torres, G.R. No. 101279, August 6, 1992). I could not find the IRR’s filing date either, so its effective date could be later than October 25, 2019.
What stands out when you read the two side by side:
- It delegates a lot. The IRR is about 22,500 words against the Act’s 9,600. The word “guidelines” appears 63 times in the IRR and 7 in the Act. For a reader, knowing the rule at a given date means reading the Act, the IRR, and then DOH and PhilHealth issuances.
- Four deadlines move. The Act counts them from “this Act”. The IRR restates each as running from “these Rules”:
| Deadline | Act | IRR |
|---|---|---|
| Comprehensive outpatient benefit within two years | Section 6(b), from the Act’s effectivity (March 8, 2021) | IRR 6.3, from the rules’ effectivity (no earlier than October 25, 2021) |
| Six years of national support to local governments that integrate | Section 41(d), from “this Act” | IRR 41.4, from “these Rules” |
| Three years of incentives for provider networks | Section 41(f) | IRR 41.6 |
| Three years for HMOs to develop a co-payment system that complements PhilHealth | Section 41(h) | IRR 41.8 |
At the earliest possible dates the shift is about 7½ months. Whether an IRR may restate a statutory deadline is a legal question I can’t answer, and the IRR doesn’t explain why it did.
- One qualifier is added. The Act says every increase in premiums or subsidy must come with “a corresponding increase in benefits”. The IRR adds “subject to financial sustainability”.
- Local integration is voluntary. Municipalities “retain their existing functions”, and the IRR extends “shall endeavor” to them.
- Some patient protections go further than the Act. No professional fees in basic or ward accommodation, and no co-payment if no bed was available (IRR 9.4–9.6).
Two things that are easy to blame on the rules are in the Act itself. The rule that no part of PhilHealth’s reserve may go to the national government, “including government-owned or -controlled corporations”, is in Section 11, and so is the condition on the independent study (Section 41(d)).
How I could be wrong
- The IRR may have a good reason for restating the deadlines that its text doesn’t give. A lawyer may also read “enactment” in the Act differently from how I did (I took it as the signing date).
- The 7½ months is a minimum. If the IRR was published later than October 10, 2019, the gap is larger.
- I compared the sections I could read side by side. I did not compare the health workforce, regulation and penal provisions line by line.
- I’m not a lawyer or a health economist. If I got a section or number wrong, please comment.
Sources
- Republic Act No. 11223 (Sections 6, 10, 11, 39, 41, 43)
- Implementing Rules and Regulations of the Universal Health Care Act, signed October 10, 2019
- Philstar, “DOH chief signs IRR of Universal Health Care” (October 11, 2019) for the signing date
- Act effectivity: PhilHealth’s UHC explainer (published in the Official Gazette February 21, 2019): philhealth.gov.ph/uhc
The UHC Series
Problem Solving the Philippines: The UHC Series.
- Part 1: What the Universal Health Care Act promises, and who has to deliver it
- Part 2: The study I can’t find, and the rules under the Act (this post)
- Part 3 (coming): Whose money? The PhilHealth reserve rule, the Supreme Court and the numbers
- Part 4 (coming): The outpatient benefit the Act promised within two years
writer’s note: due to professional reasons I am rushing out the UHC related posts.
Lovingly made with Claude.
