Health Care Provider Network (HCPN)
Referral Guidelines
Introduction
The Health Care Provider Network is a critical component of a provincial health
system as this completes the full functionality of that system. A province that has
a functioning HCPN is significantly superior in terms of improving health outcomes
compared with one that operates health facilities on an independent basis. A
province with an organized HCPN draws in the capacities of health service
organizations (HSO) in its catchment area and manages them as a unified delivery
system. In this way, regardless of the point of entry of the patient/client in the
system, he/she will be treated in the appropriate HSO.
An HCPN also solves health service delivery concerns commonly experienced by
the HSOs in their locality which are best tackled at the system level rather than by
individual institutions. The patient referral for health services is an example of a
system level concern. As such, HSOs that participate in the network must accept
the patients as clients of the network rather than individual HSOs. Therefore,
services to these clients extend beyond the walls of the HSO. It is incumbent upon
the HSOs in the network to follow certain guidelines as they jointly operate the
HCPN. These guidelines serve to standardize the referral practice in the network
and bring order in the operations in the network.
Policy anchors
The guidelines are grounded on the following policy issuances:
1. Implementing Rules and Regulations of Republic Act Number 10354 (The
Responsible Parenthood and Reproductive Health Act of 2012):
Rule 3, Section 3.01 – Definition of terms, item zz – Health Care Provider
Network (HCPN)
Rule 5 – Health Care Provider Network – Describes the HCPN operations
and procedures
Rule 14 – Conduct of Maternal Death Review and Fetal and Infant Death
Review
2. Administrative Order Number 2014-0046: Defining the SDN for Universal Health
Care or Kalusugan Pangkalahatan.
3. Department Memorandum 2014-0313: Adoption of the Guidelines in
Establishing SDN/Health Care Provider Networks
4. Administrative Order 2017-0014: Framework for Redefining SDN/Health Care
Provider Networks (HCPN)
5. LGUS Policies (Enumerate)
The above stated policies call for the organization of health service organizations
into a network thus creating a health system. A system is defined as an organized,
purposeful structure that consists of interrelated and interdependent elements
(components, entities, factors, members, parts etc.). These elements continually
influence one another (directly or indirectly) to maintain their activity and the
existence of the system, in order to achieve the goal of the system 1. The purpose
of the HCPN is to ensure continuity of care and that patients receive quality
services in appropriate facilities in a timely manner. In the context of the MNCHN-
FP program, the HCPN is aimed at optimizing maternal and neonatal health
outcomes as measured by standard indicators (i.e. MMR, IMR, NMR, UFMR).
The referral system shall be the initial component in the established HCPN. Once
done, other components of the HCPN can be added such as: systems planning,
quality assurance, information system, technology transfer/sharing, diagnostic
resource pooling, bulk procurement, manpower planning and placement etc.
Definition of client/patient referral
The Department of Health defines a referral as a set of activities undertaken by a
health care provider or facility in response to its inability to provide the necessary
intervention to its patient’s needs whether it is real or perceived. Applying this to
the HCPN system, a referral is any activity that uses other providers for services
beyond the facility’s capabilities. A functional referral system is “one that ensures
the continuity and complementation of health and medical services”. It is a
regular daily activity of linking a patient to a needed service. It also involves not
only direct patient care but support services as well (The Local Health Referral
Manual, DOH, ADB, LGU, ICHSP).
Types of referral
The referral is initiated by the facility staff and may result into: a consultation
(management is retained by the referring facility but advice was sought from
another health provider), a referral for diagnostic services (where the facility staff
orders diagnostic procedures that require sophisticated management) or a transfer
(the patient is transferred to another provider facility that continues the
management of the referred patient).
Guiding principles:
1. The HCPNs shall be organized to form a unified health delivery
system. Recognizing that the different DOH vertical programs have
different structural and procedural requirements, each vertical health
program or group of health conditions such as non-communicable
diseases shall be organized into a distinct HCPN line of service. Health
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service organizations (i.e. RHUs, BHS, Public hospitals) may then have
multiple HCPN lines as dictated by program needs.
2. The patient/client is the responsibility of the whole HCPN system. Its
system resources must be dedicated to the care of these patients
regardless of the locality where the patient is residing in their defined
catchment areas.
3. The referral system is an essential element of the operations of the
HCPN which is composed of all participating health service providers
either as sending or receiving facilities.
4. The client in transition from the referring to the receiving facility in
the network should be given the level of respect and care similar to
the health facility’s own client/patients.
5. Transportation for the conduction of emergency and urgent cases
including the availability of the driver and fuel is the responsibility of
the referring facility. The ambulance will wait for the return slip of the
patient.
6. Conduction of emergency/life-threatening referrals must be
accompanied by a health service provider from the referring facility
and a relative/guardian/significant other or a social worker.
7. Referral decisions must be grounded on good medical practice based
on best evidence.
8. Referral conditions must be listed and indications for designating
recipient facilities must be formalized. This list must be reviewed and
updated from time to time.
9. Referral guidelines must be standardized among the HCPN members
especially the transfer and acceptance procedures.
10. When making a referral, all health workers involved are expected to
maintain proper decorum (i.e. good manners, respect to fellow health
workers, appropriate uniforms, IDs, etc.) in relating with patients,
patients’ relatives and staff of referral and receiving facilities.
11. As far as possible, the receiving facility must be informed of the
referral prior to the conduction/transport of an emergency and urgent
case.
12. All cases under A2, B2, C2 Categories must have early
referral/consultation with the referring facility.
13. Records of initial management including pre-transport management
should be indicated in/attached to the referral slip. All patients in
labor from birthing facility being referred must have a copy of the
partograph.
14. All emergency and life threatening referral categories are designated
“must accept referrals”.
15. All referrals must have proper coordination with the receiving facility.
16. The receiving facility must designate a contact person and telephone
number 24/7 dedicated for “must accept” referrals both for
emergency/urgent cases and for consultation/OPD cases.
17. Receiving facilities must disseminate the clinic and specialist
schedules (i.e. subspecialty clinics, Family Planning Clinic, Diagnostic
Services) to their referring facilities and update this as often as
changes in schedule occur.
18. Receiving facilities that can no longer accommodate “must accept
referrals” for valid reasons shall become responsible for the patient
and should be the one to find and transport to the next appropriate
facility.
19. Ambulance used and accompanying service provider may be asked to
wait up to 30 minutes in case that the client has to be transported to
a higher level facility. However, coordination with the higher level
facility shall be done by the receiving facility.
20. Facilities are allowed to charge fees covering for the materials and
supplies used in the initial management, transportation cost if there is
capacity to pay assessed by the facility designated staff or if covered
by PhilHealth.
21. Monitoring of referrals within the HCPN shall be based on the referral
guidelines, among others.
22. Maternal and Neonatal Death Review and other similar activities to
review and measure results of HCPN Referral mechanism shall be
conducted.
23. As far as possible, disputes/controversies/issues/concerns among the
referring facilities shall be settled through mutual consultation and
negotiation or through arbitration. The involved parties shall mutually
agree that the Provincial Health Office shall be responsible in
organizing the arbitrating body.
24. Each component that is added in the HCPN should have a services
level provider agreement and corresponding guidelines.
25. Culture sensitivity and responsiveness must be observed during the
course of referral and the provision of services.
