PUBLIC CONSULTATION “Proposed Classification of Hospitals and Other Health Facilities” The following slides summarizes the essence of the proposed changes in the classification of hospitals and other health facilities. These materials together with the relevant inputs obtained in the public consultation will become the basis of the Administrative Order. DEPARTMENT OF HEALTH BUREAU OF HEALTH FACILITIES AND SERVICES Atty. Nicolas B. Lutero III, CESO III March 2, 2012, Duque Hall, DOH

OBJECTIVE To consult stakeholders on the “Proposed Classification of Hospitals and Other Health Facilities”.

Figure 1. Percent Distribution of DOH Licensed Hospitals as to Ownership n = 1,812 Private – 1,087 (60%) Government – 652 (36%) DOH Retained – 68 (3.75%) Source: DOH – BHFS 2010

Source: DOH – BHFS and PHIC, 2010 Figure 2. Percentage of DOH Licensed Hospitals with PhilHealth Accreditation n = 1,812 PHIC accredited – 1,603 (88.467%) Non-PhilHealth accredited – 217 (12%) Source: DOH – BHFS and PHIC, 2010

Figure 3. Percent Distribution of DOH Licensed Hospitals According to Scope of Services, n = 1, 812 General – provides services for all types of deformity, disease, illness or injury. Special – primarily engaged in the provision of specific clinical care and management. It must have ancillary and support services appropriate for a given service capability. Source: DOH – BHFS 2010

Figure 4. Number of DOH Licensed Hospitals by Service Capacity, n = 1,812 (Year 2010) Number of Hospitals

Figure 5. Percent Distribution of DOH Licensed Hospitals by Service Capacity n = 1,812 Source: DOH – BHFS 2010

Figure 6. Percent Distribution of Authorized Beds of DOH Licensed Hospitals, n = 98,154 Source: DOH – BHFS 2010

Legal Basis for Defining a Hospital Per R.A. 4226 Section 2 Section 8 Section 16 Bed space Laboratory OR X-ray Pharmacy OPD DR Isolation Morgue Classify hospitals as to: General or Special Service Capacity Size or bed capacity Training or not Beds or cribs or bassinets for 24 hour use or longer

Legal Basis for Defining a Hospital Per R.A. 4226 Section 8 Section 2 Section 16 Bed space Laboratory OR X-ray Pharmacy OPD DR Isolation Morgue Classify hospitals as to: General or Special Service Capacity Size or bed capacity Training or not Beds or cribs or bassinets for 24 hour use or longer

Legal Basis for Defining a Hospital Per R.A. 4226 Section 2 Section 8 Section 16 Bed space Laboratory OR X-ray Pharmacy OPD DR Isolation Morgue Classify hospitals as to: General or Special Service Capacity Size or bed capacity Training or not Beds or cribs or bassinets for 24 hour use or longer

Legal Basis for Defining a Hospital Per R.A. 4226 Section 2 Section 8 Section 16 Bed space Laboratory OR X-ray Pharmacy OPD DR Isolation Morgue Classify hospitals as to: General or Special Service Capacity Size or bed capacity Training or not Beds or cribs or bassinets for 24 hour use or longer All 3 Sections of the Law have to be complied with to be classified as a hospital.

CURRENT CLASSIFICATION OF HOSPITALS PER DOH A.O. NO. 2005 – 0029 LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 Primary care Level 1 plus: Level 2 plus: Level 3 plus: General Medicine Surgery Specialty Clinical Care with departmentalized clinical services Teaching and/or training with at least 1 accredited residency training program for physicians General Pediatrics Anesthesia Emergency and Out-patient Services General Dentistry Department of Emergency Medicine General Obstetrics Pharmacy Provision for ICU Specialized and sub-specialized forms of treatment, surgical procedure and intensive care Non-surgical Gynecology Secondary Clinical Laboratory Tertiary Clinical Laboratory Rehabilitation Service Minor Surgery 1st Level Radiology 2nd Level Radiology 3rd Level Radiology

INCONSISTENCY OF CURRENT CLASSIFICATION VS. LAW CATEGORY Bed space OR DR OPD Lab X-ray P I M Consistent with Law Level 1 ✓ X NO Level 2 YES Level 3 Level 4 Legend: OR – Operating Room P – Pharmacy DR – Delivery Room I – Isolation Facilities M – Morgue Level 2 – cadaver holding area Levels 3 and 4 – mortuary OPD – Out-patient Department Lab – Clinical Laboratory

INCONSISTENCY OF CURRENT CLASSIFICATION VS. LAW CATEGORY Bed space OR DR OPD Lab X-ray P I M Consistent with Law Level 1 ✓ X NO Level 2 YES Level 3 Level 4 Therefore, Level 1 does not qualify as a hospital and must be given a different category for licensure purposes.

Proposed Classification of Hospitals According to Functional Capacity: General Hospital Provides medical and surgical care to the sick and injured and maternity care and shall have as minimum, the following clinical services: medicine, pediatrics, obstetrics and gynecology, surgery and anesthesia, emergency services, out-patient and ancillary services. Specialty Hospital Specializes in a particular disease or condition or in one type of patient. Teaching/Research Hospitals Teaching/training sites for physicians and other health professionals. It may be linked with medical school(s) or universities for medical research. GENERAL HOSPITAL – Provides services for all types of deformity, disease, illness and/or injury. SPECIALTY HOSPITAL – a hospital that has advanced capabilities pertaining to the type of service offered. TEACHING/RESEARCH HOSPITAL – in addition to teaching, are training sites for physicians and other health professionals.

Classification of General Hospitals CURRENT PROPOSED LEVEL I RE-CLASSIFY TO PRIMARY CARE FACILITY LEVEL 2 LEVEL 1 LEVEL 3 LEVEL 4

PROPOSED LEVEL 1 LEVEL 2 LEVEL 3 Clinical Services for in-patients Medicine Pediatrics OB-GYNE Surgery Anesthesia Level 1 plus: Level 2 plus: Departmentalized Clinical Services Teaching with accredited residency training program in the 4 major clinical services Emergency and Out-patient Services Respiratory Unit Department of Emergency Medicine Maternity Facilities ICU Rehabilitation unit Isolation Facilities Dental Unit Ambulatory Surgical Clinic Dialysis Clinic Ancillary Services Secondary Clinical Laboratory Tertiary Clinical Laboratory Tertiary lab with histopathology Blood Bank 1st Level X-ray 2nd Level X-ray with mobile unit 3rd Level X-ray Pharmacy Minimum Characteristics of the Proposed General Hospital Classification

PROPOSED CLASSIFICATION OF OTHER HEALTH FACILITIES B C D Primary Care Facility Custodial Care Facility Diagnostic Facility Specialized Out-patient Facility With in-patient Beds: Infirmary/ Dispensary Birthing Home Psychiatric Care Facility Laboratories: Clinical Lab/ HIV Blood Service Facilities Drug Test Lab NB Screening Lab Water Lab Dialysis Clinic (DC) Without Beds: Medical Out-patient Clinics OFW Clinics Dental Clinics Drug Abuse Treatment and Rehabilitation Center (DATRC) Radiologic Facility with X-ray, CT scan, mammography, etc. Ambulatory Surgical Clinic (ASC) Leprosarium Biophysical Tests, Ultrasound, 2-D Echo, Stress Test, ECG, MRI In-Vitro Fertilization (IVF) Centers Nursing Home Nuclear Medicine Philippine Oncology Center Primary Care Facility – usually a first contact facility which may offer in-patient and/or out-patient basic services. Birthing Facility – a health facility that provides maternity service on pre-natal and post-natal care, normal delivery and care of newborn babies.

PROPOSED CLASSIFICATION OTHER HEALTH FACILITIES HOSPITALS OTHER HEALTH FACILITIES General Level 1 Level 2 Level 3 Primary Care Facility Specialty Custodial Care Facility Teaching/ Research Diagnostic Facility Specialized Out-patient Facility This is the summary of the proposed classification.

DOH Website www.doh.gov.ph Doing Business Licensing BHFS Requirements Hospitals and Other Health Facilities

BUREAU OF HEALTH FACILITIES AND SERVICES Division Chief Contact Number/ Email Address Standards Development Division Dr. Cynthia R. Rosuman 6517800 local 2525 7119572 (direct) cyros88@gmail.com Licensing and Accreditation Division Atty. Rodel C. Flores (OIC) 6517800 local 2502-2504 7116982 (direct) ledor72@yahoo.com Quality Assurance and Monitoring Division Dr. Beauty A. Palongpalong 6517800 local 2528 bapalongpalong@yahoo.com Administrative Unit Ms. Teresa Salgado 6517800 local 2500

Thank you.

Particular Group of Patients SPECIALTY HOSPITALS Particular Disease Particular Organ(s) Particular Group of Patients National Orthopedic Hospital Lung Center Philippine Children’s Medical Center National Center for Mental Health Philippine Heart Center Dr. Jose Fabella Memorial Hospital San Lazaro Hospital National Kidney and Transplant Institute Philippine Geriatric Center