AN ACT ESTABLISHING THE PHILIPPINE MEDICAL CARE PLAN AND CREATING THE PHILIPPINE MEDICAL CARE COMMISSION

Case Overview and Summary

Summary of Republic Act No. 6111 (Philippine Medical Care Act of 1969)

Declaration of Policy (Section 2):
- Provide total medical service for the people by adopting a comprehensive medical care program based on:
  • Total coverage of medical services according to patient needs.
  • Coordination and cooperation in using government and private medical facilities.
  • Preserving freedom of choice of physicians, hospitals, and doctor-patient relationship.

Purposes and Objectives (Section 3):
  • Extend medical care to all residents within the nation's economic means. (Section 3a)
  • Provide a practical means for people to help pay for adequate medical care. (Section 3b)
  • Establish a Medical Care Commission. (Section 3c)

Philippine Medical Care Commission (Section 4):
  • Composed of 9 members, including a Chairman and Vice-Chairman (Administrator).
  • Chairman and 2 private sector members appointed by the President for 6 years.

Functions and Powers of the Commission (Section 5):
  • Formulate policies, administer, and implement the Medical Care Plan. (Section 5a)
  • Organize offices, fix compensation, and appoint personnel. (Section 5b)
  • Establish provincial, city, and municipal Medical Care Councils. (Section 5c)
  • Authorize actuarial studies to determine contributions and benefits. (Section 5d)
  • Set requisites and procedures for registering beneficiaries. (Section 5e)
  • Devise control measures to prevent abuses. (Section 5f)
  • Provide funds to Medical Care Councils to carry out functions. (Section 5g)
  • Withhold benefits from those who refuse to pay contributions, except emergencies. (Section 5h)
  • Promulgate supplementary rules and regulations. (Section 5i)
  • Submit annual report to the President and Congress. (Section 5j)
  • Exercise all necessary powers to attain the Commission's objectives. (Section 5k)

The Philippine Medical Care Plan (Section 9):
  • Program I: For SSS and GSIS members.
  • Program II: For those not covered in Program I.

Program I: Medical Care for SSS and GSIS Members (Sections 10-26)
  • Compulsory coverage for all employees entitled under Section 35. (Section 11)
  • Employees can continue paying contributions after separation from employment. (Section 12)
  • Hospitalization expense benefit: room and board up to P12/day, special charges up to P150. (Section 13)
  • Surgical expense benefit: up to P50 for minor, P150 for medium, P350 for major operations. (Section 14)
  • Medical expense benefit: P5 per daily visit by practitioner, up to P100 per confinement. (Section 15)
  • Free choice of hospital and medical practitioner. (Section 16)
  • Notification of illness, confinement, and supervision by SSS/GSIS. (Section 17)
  • Direct payment of benefits to hospitals, practitioners, and drug stores. (Section 18)
  • Limitations on right to benefits based on contributions, notification, and compliance. (Section 19)
  • Exclusions: cosmetic surgery, dental services, optometric services, psychiatric illnesses, and purely diagnostic services. (Section 20)
  • Contribution rates based on monthly salary/wage. (Section 21)
  • Employers to deduct and remit employee and employer contributions. (Section 22)
  • Health Insurance Fund created from contributions. (Section 23)
  • Administration and disbursement of funds by SSS and GSIS. (Section 24)
  • Contributions to be deposited in interest-bearing government deposit banks. (Section 25)
  • Keeping records of operations, disbursements, and data for actuarial valuations. (Section 26)

Program II: Hospitalization, Out-Patient, and Domiciliary Care (Sections 27-34)
  • Private hospitals to set aside 20% of beds as service beds subsidized at P10/bed/day. (Section 27)
  • Priority for hospital loans from government financing institutions. (Section 27)
  • Out-patient and domiciliary care initially by government hospitals, rural health units, and clinics. (Section 27)
  • Registration and yearly assessments for residents to be entitled to benefits. (Section 28)
  • Establishment of Provincial, City, and Municipal Medical Care Councils. (Sections 29-31)
  • Community Mutual Health Fund established in each city/municipality from resident contributions and government counterpart. (Section 32)
  • Gross income of government hospitals to be a revolving fund for upgrading, expansion, and maintenance. (Section 33)
  • Reparations Commission to allocate funds for procuring medical equipment and supplies. (Section 34)
  • Definitions of terms used in the Act. (Section 35)

Other Provisions:
  • Study and research by the Commission to determine contributions and benefits. (Section 36)
  • Penal provisions for fraud, misrepresentation, and misuse of funds. (Section 37)
  • Separability clause. (Section 38)
  • Repealing inconsistent laws and preserving existing agency powers. (Section 39)
  • Appropriation of P1 million for initial organizational expenses. (Section 40)
  • Program I to be implemented immediately, Program II as determined by Congress. (Section 41)