Governance Senate

Get to know RA No. 11463 or the Malasakit Center Act of 2019

BACKGROUNDER

What is Republic Act No. 11463?

It is the Malasakit Center Act of 2019 which was signed into law by President Rodrigo Duterte on December 2, 2019. It is a pet bill of Sen. Christopher Lawrence “Bong” Go.

What is a Malasakit Center?

It is a one-stop shop for all government medical and financial assistance for all Filipinos, particularly the poor and indigent patients.

It shall be non-partisan, convenient, free of charge, accessible and shall have a standard system of availment of assistance.

What are its primary objectives?

RA No. 11463 seeks to make it more convenient and accessible for Filipinos seeking medical and financial assistance from the government by putting all concerned agencies under one roof.

It aims to bring down to lowest amount possible, if not zero-balance, the hospital bill, including out-of-pocket expenditures, of particularly poor and indigent Filipinos.

How was the Malasakit Center initiative conceived?

Sometime in 2017, then Special Assistant to the President, now Sen. Go, discussed with President Duterte the possibility of putting under one roof all government agencies that give various medical and financial assistances, to be housed in select hospitals in the country.

Poor and indigent patients or their representative would go to individual offices scattered in separate locations, often one agency per day, seeking those assistance.

When President Duterte was still mayor then of Davao City, people even from Surigao provinces, North Cotabato, Bukidnon and other places, used to go to the office of the City Mayor of Davao to ask for financial assistance.

How different are the Malasakit Centers under RA No. 11463 and the Malasakit Centers that had been launched before this law?

The whole Malasakit Center initiative started as a convergence initiative of the Office of the President. In order to ensure the continuity of the program even after the term of President Duterte, a law is needed to institutionalize the program.

The Malasakit Centers already launched will continue to exist and will be operated and managed under the Malasakit Center Act of 2019.

ADOPTION AND IMPLEMENTATION OF MALASAKIT PROGRAM

Which agency shall establish a Malasakit Program?
DOH shall establish a Malasakit Program that all DOH hospitals and the PGH shall adopt and implement.

The Malasakit Program shall have the following objectives:
1. It provides a policy framework for integrated people-centered health services that shall: (a) ensure and promote an organizational culture geared towards responsiveness; (2) ensure appropriate infrastructure and processes; and (3) promote client engagement and empowerment; and

2. It ensures financial risk protection and alleviate the financial burden of indigent and financially incapacitated patients and families who avail of health services in public hospitals through financial and medical assistance provided through financial and medical assistance provided by national government agencies, local government, nongovernment organizations, private corporations and individuals.

Distinguish “indigent patients” from “financially incapacitated patients”
“Indigent patient” refers to patient who has no visible means of income, or whose income is insufficient for the subsistence of his/her family, as assessed by the Department of Social Welfare and Development (DSWD), local government social worker or the medical social worker of the health facility.

In contrast, “Financially incapacitated patient” refers to a patient who is not classified as indigent but who demonstrates clear inability to pay or spend for necessary expenditures for one’s medical treatment.

SERVICES AND ASSISTANCE OFFERED AND TARGET BENEFICIARIES

The roles of a Malasakit Center in DOH hospitals are as follows:
a. It serves as one stop shop for medical and financial assistance;

b. It provides patient navigation and referral to the health care provider networks;

c. It provides information with regard to membership, coverage and benefit packages in the National Health Insurance Program;

d. It documents, processes, and utilizes data from patient experience through a standardized form to shape institutional changes in the hospital.

e. It provides capacity-building and performance evaluation to ensure good client interaction; and

f. It provides critical information on healthy behaviors and conduct promotion activities in the hospital.

Malasakit Centers facilitate the following medical and financial assistance:
a. Medical assistance to indigent patients from the Department of Health (DOH).

b. Financial assistance, based on existing Assistance to Individuals in Crisis Situation (AICS) guidelines, from the Department of Social Welfare and Development (DSWD).

c. Medical assistance under the existing programs of the Philippine Charity Sweepstakes Office (PCSO), chargeable against its own funds.

d. Medical and financial assistance programs provided by other government agencies, local government units (LGUs), non-government organizations and private institutions and individuals.

What is “medical assistance”?
Medical assistance refers to assistance for out-of-pocket for out-of-pocket expense in the form of coupon, stub, guaranty letter, promissory note or voucher that has monetary value, given directly to recipients or beneficiaries to be used for the purchase of drugs, medicines, goods or other services prescribed by the physician of a health facility for in- and out-patients.

What is “financial assistance”?
Financial assistance refers to monetary aid, in the form of guaranty letter, cash or check, which covers burial, transportation, and other allied assistance or physical aid, such as food, clothing, general assistive devices, given by agencies and mandated by existing laws, rules and regulations to provide such assistance.

What is an out-of-pocket expenditure?
It is any medical or surgical services not currently paid for or sufficiently reimbursed by PhilHealth under the Universal Health Care Law or other financing sources.

Who are considered as indigent and poor patients?Indigent patients are those who have no visible means of income, or whose income is insufficient for the subsistence of their family, as identified by the DSWD, LGU social worker or the medical social worker of the health facility.

Poor patients are those not classified as indigent but are otherwise considered poor or with financial difficulty to access adequate medical care and/or pay hospital bills because of certain unavoidable circumstance.

Poor patients may refer to any of the following:
a. Senior citizens, persons with disability, orphans, abused women and children as defined by the Anti-Violence Against Women and Their Children Act of 2004 (RA 9262) and the Special Protection of Children Against Abuse, Exploitation and Discrimination Act (RA 7610);

b. Patients with catastrophic illness or any illness as a primary condition that is life or limb-threatening and requires prolonged hospitalization, extremely expensive therapies or other special but essential care that would deplete one’s financial resources, unless covered by special health funding policies;

c. Unemployed or without gainful employment;

d. Suspected or confirmed victims of torture as defined by the Anti-Torture Act of2009 (RA 9745);

e. Soldiers and police rendered disabled to be gainfully employed and their dependents and dependents of soldiers and police killed in action;

f. Rebel returnees, prisoners of war and their dependents; or

g. Victims of calamities or disasters such as but not limited to typhoons, earthquake, whose place of residence are officially under a state of emergency or calamity.

May medical and financial assistance through the Malasakit Centers or through the government agencies concerned be extended to patients who are admitted in LGU and other public hospitals but who are otherwise eligible for medical and financial assistance under the “Malasakit Centers Act”?

Yes. Medical and financial assistance through the Malasakit Centers or through the government agencies concerned may be extended to patients who are admitted in LGU and other public hospitals but who are otherwise eligible for medical and financial assistance under the “Malasakit Centers Act”.

May DOH hospital enter into a contract with DOH-accredited private health facility in case of non-availability of clinically indicated drugs?

Yes. DOH hospital may enter into a contract with DOH-accredited private health facility to provide the needed drug, test, service or procedure to the patient charged against the hospital in case of non-availability of clinically indicated drugs.

ESTABLISHMENT, ADMINISTRATION AND MANAGEMENT OF MALASAKIT CENTERS

Where shall the Malasakit Centers be established?

The Malasakit Centers shall be established in all 73 DOH-run hospitals and in the Philippine General Hospital.

What is a DOH-run hospital?

It is a hospital under the management and administration of DOH, including the four corporate hospitals under the Health Secretary, namely: Philippine Heart Center, Lung Center of the Philippines, National Kidney and Transplant Institute and the Philippine Children’s Medical Center.

The Philippine General Hospital, although specifically mentioned by the Malasakit Center Act of 2019, is not a DOH-run hospital. It is managed and administered by the University of the Philippines Manila.

What agencies are found inside a Malasakit Center? What are their respective functions?

Each Malasakit Center shall have the duly designated representatives of DOH, DSWD, PCSO and PhilHealth.

The DOH, DSWD and PCSO representatives will process and approve the requests for medical and financial assistance.

The PhilHealth representative shall assist in the availment of benefits and address other PhilHealth-related concerns of patients.

Is there a special lane for senior citizens and persons with disabilities in the Malasakit Centers?

Yes, there is a special lane in each Malasakit Center for senior citizens and PWDs.

May LGU hospitals also establish their own Malasakit Centers?

Yes, provided they meet the following standards:

a. Guarantee the availability of funds for the operations of the Malasakit Centers, including its maintenance and other operating expenses, personnel complement including staff training, performance assessment and monitoring;

b. Ensure the adoption of the integrated people-centered health services; and

c. Comply with other requirements to be prescribed by the DOH regarding service capacity and capability, location, among others.

What is an LGU hospital?

It refers to a hospital managed by the local government units, usually the provincial and big city government.

Which agency shall establish a Malasakit Program?

DOH shall establish a Malasakit Program that all DOH hospitals and the PGH shall adopt and implement.

Does the law establish an Office in DOH which augments, reclassifies and strengthens the existing Public Assistance Unit (PAU) of DOH?

Yes. A Malasakit Program Office shall be established in the DOH by augmenting, reclassifying and strengthening the existing PAU of the DOH. The Malasakit Program Office shall oversee the operations of the Malasakit Centers.

Who shall administer the Malasakit Centers?

The incumbent Medical Center, Chief of Hospital or Medical Center shall be designated as the Malasakit Center Director. He or she oversees the proper management and efficient operation of the Malasakit Center.

What are the duties and functions of the Malasakit Center Director?

1. He or she ensures that the provision of appropriate space, furniture, equipment and fixtures based on the standard Malasakit Centers schematic plan to be provided by the DOH;

2. He or she promotes harmony, coordination and cooperation among the participating agencies in the Malasakit Centers and strengthens the delivery of services by upholding the highest performance of duties and responsibilities; and

3. He or she performs other functions as may be necessary for the accomplishment of the objectives of the Malasakit Program.

Who shall take charge of the day-to-day management and operations of the Malasakit Centers?

The Head of the Medical Social Work Office as the Malasakit Center Operations Manager shall take charge of the day-to-day management and operations of the Malasakit Centers.

Who shall assign the Medical Social Work Office as the Malasakit Center Operations Center Manager?

The Malasakit Center Director.

Do Malasakit Center Director and Malasakit Center Operations Manager receive extra compensation?

No. They do not receive extra compensation.

Shall the Malasakit Center be staffed by medical social workers and support staff?

Yes. The Malasakit Center shall be adequately staffed by medical social workers and support staff. The Medical Director, Chief of Hospital or Medical Center Chief shall appoint and assign such other personnel as may be necessary for the effective operation of the Malasakit Centers.

Which agencies shall issue the uniform guidelines for the implementation of medical and financial assistance to indigent and financially incapacitated patients?

DOH, DSWD, PhilHealth and the PCSO shall issue uniform guidelines for the proper implementation of medical and financial assistance to indigent and financially incapacitated patients, which shall include availment procedures, order of charging of payments, recording and reporting and monitoring and evaluation.

In the implementation of the Malasakit Centers Act, what shall be the primary consideration?

The efficient and most streamlined delivery of assistance to all beneficiaries shall be the primary consideration.

Are DOH, DSWD, PCSO and the PhilHealth authorized to create the required plantilla and staffing pattern necessary for the implementation of the “Malasakit Center Centers Act”?

Yes. DOH, DSWD, PCSO and the PhilHealth are authorized to create the required plantilla and staffing pattern necessary for the implementation of the “Malasakit Center Centers Act” with the DBM, CSC and GCG, as the case may be. DOH and the DSWD shall include in their budgetary permission to the DBM the required budget for the personnel services requirements of each Malasakit Center. Such budgetary requirements shall be included in the budgets of the respective agencies in the GAA.

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