The Innovation of Six-Dimensional Pooling Risk Framework in Universal Health Insurance Coverage

Abstract

This study aims to transform the existing three-dimensional pooling risk framework of the health insurance Bismarck model to finance health promotion, disease prevention, treatment, and palliative health care services, and equity in low-density population districts. A case study design was used to synthesize the health insurance Bismarck model with sustainable development goals (SDGs) 1, 2, 3, 6, and 10, the four types of preventions, universal health coverage (UHC) frameworks, the District Division Administrative Disaggregation Data framework, and others theoretical frameworks. The Precede-Proceed Planning Model was implemented to formulate the six-dimensional pooling risk framework. The innovative cross-subsidization of the framework was developed based on the rich subsidizing the poor, healthy people subsidizing sick people, the young subsidizing the elderly, the healthy people subsidizing for their health promotion, and disease prevention, and high-density population districts subsidizing for equity in low-density population districts. In conclusion, the innovative six-dimensional pooling risk framework of health insurance Bismarck model functions to remobilize health care resources toward the four types of health care services of UHC and equity in low-density population districts. The premium of the model is demanded to transform based on probability of health and illness, and equity in low-density population districts.