Ao2020-0019 Guidelines On The Service Delivery Design of Health Care Provider Networks
Ao2020-0019 Guidelines On The Service Delivery Design of Health Care Provider Networks
Ao2020-0019 Guidelines On The Service Delivery Design of Health Care Provider Networks
Republic
Department of Health
OFFICE OF THE SECRETARY
MAY 14 2020
ADMINISTRATIVE ORDER
0014
No. 2020—_
I. RATIONALE
The Universal Health Care (UHC) Act or Republic Act 11223 is anchored on an
integrated and comprehensive approach for
the health system to ensure that all Filipinos
are health literate, provided with healthy living conditions, and protected from hazards
and risks that could affect their health.
Section 18 of the UHC Act provides the formation of health care provider networks
(HCPNs) that ensure integration and effective and efficient delivery of population-
based and individual-based health services. HCPNs may be composed integrated of
local health systems (the province-wide or city-wide health systems), networks of
private health care providers to complement the health services provided by public
health facilities, or mixed public-private networks of health service providers. In
addition, the DOH is mandated to identify apex or end-referral hospitals for patients
needing specialized care not available within the HCPNs.
UHC Implementing Rules and Regulations (IRR) in Section 18 provides that HCPNs
shall receive performance driven, closed-end, prospective payments from PhilHealth
based on diagnosis-related groupings. Apex or end-referral hospitals may be contracted
as stand-alone facilities by PhilHealth.
To support the implementation of the UHC Act and its IRR, and to ensure that all
Filipinos have access to quality health care, the following guidelines are hereby issued.
II. OBJECTIVES
A. General Objective
This Order shall set the standards of HCPNs and apex hospitals to ensure that the
continuum of care is delivered through a people-centered and integrated health system.
B. Specific Objectives
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To provide guidelines for the establishment of
public health units in hospitals.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http:/Avww.doh.gov.ph; e-mail: {tduque@doh.gov.ph
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III. SCOPE OF APPLICATION
This Order shall apply to all Department of Health (DOH) offices and all
its units and
instrumentalities, including the Centers for Health Development (CHDs), hospitals,
PhilHealth, and other attached agencies. Likewise, this shall also apply to all public
and private health facilities, Local Government Units (LGUs), and other relevant
stakeholders on establishing HCPNs.
A. Apex or End-Referral Hospital — The terms apex and end-referral hospital are used
interchangeably in these Guidelines. It refers to a hospital, offering specialized
services as determined by DOH, which is contracted as a stand-alone facility by
PhilHealth.
Public Health Unit (PHU) - a unit in the hospital facilitating the provision of
population-based services, implementation of national public health programs,
coordination with primary care provider networks, and provision of a one-stop shop
patient navigation system within the hospital.
Health Station — is a private or a public health facility that functions to augment the
delivery of public health services of a Primary Care Facility (Annex A).
GENERAL GUIDELINES
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B. All HCPNs shall have functional care coordination with the PCPN serving as the
patient’s initial-contact and navigator.
E. All HCPNs shall have primary to tertiary care providers with linkages to an apex
hospital and other facilities providing specialized services needed
its catchment
by
population.
F. All DOH hospitals shall endeavor to become apex hospitals; Provided that, in the
interim, DOH Hospitals that currently do not qualify as apex hospitals may be
contracted by PhilHealth as stand-alone facilities.
G. The DOH
shall
determine eligible apex or end-referral hospitals. These apex or
end-referral hospitals shali be contracted as stand-alone facilities based on the
guidelines issued by PhilHealth.
H. All hospitals shall have a Public Health Unit to facilitate the implementation of
population-based health services and seamless patient navigation within the HCPN.
The HCPN shall be composed of PCPN providing primary care service, and
hospitals delivering secondary and tertiary general health care.
1. The PCPN shall be composed of the following health facilities that provide
population and/or individual-based primary care services:
a. Primary Care Facilities, such as Rural Health Units, Health Centers, and
Medical Outpatient Clinics, which shall ensure proper coordination and
service delivery across the PCPN; and,
b. Other health facilities necessary for the delivery of primary care, such as
but not limited to,health stations, stand-alone birthing homes, stand-alone
laboratories, pharmaceutical outlets, and dental clinics.
2. The following health facilities, whether public or private, shall provide general
in-patient care services for the HCPN:
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b. Hospitals, as classified by the DOH, which shall include:
1. At least one Level 1 providing secondary care; and,
2. At least one Level 2 or 3 hospital providing tertiary care.
B. Network-wide Requirements
All participating health facilities shall annually comply with the Health
Facility Profiling of DOH and PhilHealth.
A directory and map of all the health facilities in the HCPN with all the
services provided, address, clinic hours, and contact numbers shall be
posted in each health facility.
All HCPNs and their apex hospitals shall endeavor to meet access standards
for health facilities in alignment with the Philippine Health Facility
Development Plan, wherein people shall have access to a primary care
facility within thirty (30) minutes travel time and to a hospital within one
(1) hour.
g. Capacity building and mentoring activities of all health facilities within the
network to improve service capability and health human resource
competencies.
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a. Network-wide health outcomes including morbidity and mortality reviews,
compliance with financial risk protection measures, and patient care and
responsiveness;
g. Accessibility and adequacy for health facilities and human resources for the
catchment population.
2. Public HCPNs shall follow current legal frameworks and policies for
partnership with the private sector including, but not limited to, the following:
1. Apex hospitals shall be linked to HCPNs and shall deliver specialty health care
services not expected to be provided in HCPNs.
a. The DOH shall determine eligible apex hospitals based on the following
service capability:
i. A single-specialty hospital that is designated by law or licensed by the
ii.
DOH,
or
A general hospital with the following:
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1. Accredited teaching and training in at least the following four
major departments namely, Medicine, Pediatrics, Surgery, and
Obstetrics and Gynecology; and,
2. Atleast two Specialty Centers according to DOH standards.
ce. Apex hospitals may be owned and managed by DOH, other National
Government Agencies, State Universities and Colleges, or private entities.
2. All HCPNs shall have linkage with Drug Abuse and Treatment Rehabilitation
Centers, Blood Centers, among others.
1. The PHU shall ensure that hospital policies are aligned with national public
health programs.
The PHU shall assist the hospital management in ensuring surveillance and
reporting of notifiable diseases through the disease surveillance officer or
disease surveillance coordinator.
The PHU shall ensure proper referral and navigation of patients within the
hospital and from the hospital to primary care facilities and other necessary
facilities in the network.
4. The PHU shall be established under the Office of the Medical Center Chief or
Chief of Hospital with the following minimum dedicated or designated staff
(see Annex E):
c. Administrative staff.
1. Coordinate with concerned Central Office units for the provision of technical
assistance to CHDs, Local Health Systems, and HCPNs;
1. Set licensing standards for primary care facilities and other health facilities in
the HCPN; and,
G. PhilHealth
1. Ensure that the HCPN design, requirements and support mechanisms are
available within their jurisdiction;
3. Endeavor to meet the gaps of health facilities, human resources, equipment and
infrastructure within their jurisdiction; and,
If any part or provision of this Order is rendered invalid, by any court of law or
competent authority, the remaining parts or provisions not affected shall remain valid
and effective.
x. REPEALING CLAUSE
Ali Orders, rules, regulations, and other related issuances inconsistent with or contrary
to this Order are hereby repealed, amended, or modified accordingly. All other
provisions of existing issuances which are not affected by this Order shall remain valid
in
and effect.
EFFECTIVITY
10
Annex A. Primary Care Facility Services
(Refer to Primary Care Facility Manual)
PT/OT/ST Optional No
Licensing Yes No
*Public Primary Care Facility shall deliver population-based services. *Can
be a one-stop shop service provider or not
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4
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:
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Receiving Facility with
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Referral Form
SITUATION
Iam (name), (position) of (initiating facility)
Iam calling about an emergency referral
Who
am I talking with? [Wait for Response 1]
S Patient is a (age), (sex) with chief
complaint/problem: (state chief complaint) Present
working impression is: (Working Impression)
Reason for referral is: (state reason)
Current vital signs are: (BP, HR, RR, O2 Sats, Temp)
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*..|-(Name of patient) nas
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ASSESSMENT
A I think the problem/concern is: (describe)
(state issues for the referral)
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a We would liké to transfer. the ‘patient immediately.
Response
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Annex D. Uniform Referral Form
Findings
Vital Signs: 8P. HR RR. O2 sats Temp Weight
(atta ch laboratory results)
Treatment Given
(atta ch treatment cards}
Personnel Hospitals
Health education
public Health Advisor
and promotion
Health education and Health education and
Health education promotion once promotion officer
and promotion officer/disease : Disease surveillance
surveillance officer
officer surveillance
:
officer
Disease
coordinator Disease surveillance
surveillance
:
coordinator
:
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coordinator
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