Theoretical Framework of Universal Health Care Fiscal Architecture
Universal health care financing models rely on the systematic restructuring of revenue mobilization to mitigate catastrophic out-of-pocket household expenditures. Under the framework established by Republic Act 11223, statutory revenue streams combine automatic national health insurance enrollment with designated tax-based appropriations [2], [5]. This design seeks to consolidate fragmented pooling mechanisms into a single-payer architecture capable of cross-subsidizing high-cost interventions while expanding universal access to essential primary care services [5]. However, conceptual models of progressive financing encounter structural friction when superimposed onto decentralized governance systems [2]. Centralized statutory pooling assumes uniform institutional absorption capacity across subnational units, yet local government units operate under disparate fiscal baselines and regulatory personnel expenditure caps [1], [2]. These statutory ceilings constrain local authorities from hiring required clinical and financial administrative personnel, creating a significant divergence between legal coverage entitlements and local budgetary realities [1]. Furthermore, while tax-based revenue allocations bolster subnational health funds, variations in administrative accountability and digital financial monitoring generate regional disparities in resource utilization [2]. Consequently, achieving financial protection requires not only the statutory mobilization of funds at the central level but also coordinated fiscal mechanisms that bridge national allocations with devolved operational expenditures [1], [5].