SEC. 13. PhilHealth Board of Directors. - (a) The PhilHealth Board of Directors, hereinafter referred to as the Board, is hereby reconstituted to have a maximum of thirteen (13) members, consisting of the following: (1) five (5) ex-officio members, namely: the Secretary of Health, Secretary of Social Welfare and Development, Secretary of Budget and Management, Secretary of Finance, Secretary of Labor and Employment; (2) three (3) expert panel members with expertise in public health, management, finance, and health economics; and (3) five (5) sectoral panel members, representing the direct contributors, indirect contributors, employers group, health care providers to be endorsed by their national associations of health care institutions and health care professionals, and representative of the elected local chief executives to be endorsed by the League of Provinces of the Philippines, League of Cities of the Philippines, and League of Municipalities of the Philippines: Provided, That at least one (1) of the expert panel members and at least two (2) of the sectoral panel members are women.
The sectoral and expert panel members must be Filipino citizens and of good moral character.
The expert panel members must: (i) be of recognized probity and independence and must have distinguished themselves professionally in public, civic or academic service; (ii) to be in the active practice of their professions for at least seven (7) years; and (iii) not be appointed within one (1) year after losing in the immediately preceding elections, whether regular or special.
(b) The Secretary of Health shall be an ex officio non-voting Chairperson of the Board.
(c) All appointive members of the Board shall be required to undergo training in health care financing, health systems, costing health services and HTA prior to the start of their term. Non-compliance shall be a ground for dismissal.
Within thirty (30) days following the effectivity of this Act, the Governance Commission for Government-Owned or -Controlled Corporations (GCG) shall, in accordance with the provisions of Republic Act No. 10149, promulgate the nomination and selection process for appointive members of the Board with a clear set of qualifications, credentials, and recommendation from the concerned sectors.
SEC. 14. President and Chief Executive Officer (CEO) of PhilHealth. - Upon the recommendation of the Board, the President of the Philippines shall appoint the President and CEO of PhilHealth from the Board's non-ex officio members: Provided, That the Board cannot recommend a President and CEO of PhilHealth unless the member is a Filipino citizen and must have at least seven (7) years of experience in the field of public health, management, finance, and health economics or a combination of any of these expertise.
SEC. 15. PhilHealth Personnel as Public Health Workers. - All PhilHealth personnel shall be classified as public health workers in accordance with the pertinent provisions under Republic Act No. 7305, also known as the Magna Carta of Public Health Workers.
SEC. 16. Additional Powers and Functions of PhilHealth. - (a) To fix the reasonable compensation, allowances and other benefits of all positions, including its President and CEO, based on a comprehensive job analysis and audit of actual duties and responsibilities, subject to the approval of the President of the Philippines. The compensation plan shall be comparable with government social securit institutions and shall be subject to periodic review by the Board no more than once every four (4) years without prejudice to merit reviews or increases based on productivity and efficiency;
(b) To establish the organizational structure and staffing pattern of PhilHealth's central and regional offices to cover as many provinces, cities and legislative districts, including foreign countries, whenever and wherever it may be expedient, necessary and feasible and to inspect or cause to be inspected periodically such offices, subject to the approval by the Board;
(c) To maintain a Provident Fund which consists of contributions made by both PhilHealth and its officials and employees and earnings thereon, for the payment of benefits to such officials and employees or their dependents or heirs under such terms and conditions as may be prescribed by the Board, subject to the approval of the President of the Philippines; and
(d) To adopt or approve the annual and supplemental budget of receipts and expenditures including salaries, allowances and early retirement of PhilHealth personnel and to authorize such capital and operating expenditures and disbursements as may be necessary and proper for the effective management and operation of PhilHealth: Provided, That this shall be subject to the budgetary limitations stated under Section 12 hereof: Provided, further, That the submission of the corporate budget to the Department of Budget and Management (DBM) shall be for information purposes only.
CHAPTER IV
HEALTH SERVICES DELIVERY
SEC. 17. Population-based Health Services. - The DOH shall endeavor to contract province-wide and city-wide health systems for the delivery of population-based health services. Province-wide and city-wide health systems shall have the following minimum components:
(a) Primary care provider network with patient records accessible throughout the health system;
(b) Accurate, sensitive, and timely epidemiologic surveillance systems; and
(c) Proactive and effective health promotion programs or campaigns.
SEC. 18. Individual-based Health Services. - (a) PhilHealth shall endeavor to contract public, private, or mixed health care providider networks for the delivery of individual-based health services: Provided, That member access to services shall not be compromised: Provided, furthermore, That during the transition, PhilHealth and DOH shall incentivize health care providers that form networks: Provided, finally, That apex or end-referral hospitals, as determined by the DOH, may be contracted as stand-alone health care proiders by PhilHealth.
(b) PhilHealth shall endeavor to shift to paying providers using performance-driven, close-end, prospective payments based on disease or diagnosis related groupings and validated costing methodologies and without differentiating facility and professional fees; develop differential payment schemes that give due consideration to service quality, efficiency and equity; and institute strong surveillance and audit mechanisms to ensure networks' compliance to contractual obligations.
CHAPTER V
ORGANIZATION OF LOCAL HEALTH SYSTEMS
SEC. 19. Integration of Local Health Systems into Province-wide and City-wide Health System. - The DOH, Department of the Interior and Local Government (DILG), PhilHealth and the LGUs shall endeavor to integrate health systems into province-wide and city-wide health systems. The Provincial and City Health Boards shall oversee and coordinate the integration of health services for province-wide and city-wide health systems, to be composed of municipal and component city health systems, and city-wide health systems in highly urbanized and independent component cities, respectively. The Provincial and City Health Boards shall manage the Special Health Fund referred to in Section 20 of this Act and shall exercise administrative and technical supervision over health facilities and health human resources within their respective territorial jurisdiction: Provided, That municipalities and cities included in the province-wide and city-wide health systems shall be entitled to a representative in the Provincial or City Health Board, as the case may be.
SEC. 20. Special Health Fund. - The province-wide or city-wide health system shall pool and manage, through a special health fund, all resources intended for health serives to finance population-based and individual-based health services, health system operating costs, capital investments, and remuneration of additional health workers and incentives for all health workers: Provided, That the DOH, in consultation with the DBM and the LGUs, shall develop guidelines for the use of th Special Health Fund.
SEC. 21. Income Derived from PhilHealth Payments. - All income derived from PhilHealth payments shall accrue to the Special Health Fund to be allocated by the LGUs exclusively for the improvement of the LGU health system: Provided, That PhilHealth payments shall be credited to the annual regular income (ARI) of the LGU.
SEC. 22. Incentives for Improving Competitiveness of the Public Health Service Delivery System. - The National Government shall make available commensurate financial and non-financial matching grants, including capital outlay, human resources for health and health commodities, to improve the functionality of province-wide and city-wide health systems: Provided, That underserved and unserved areas shall be given priority in the allocation of grants: Provided, further, That the grants shall be in accordance with the approved province-wide and city-wide health investment plans, which shall account for complementation of public and private health care providers and public or private health sector investments.
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