Improving Health System Performance Using Risk Pooling Mechanism: Case Study

Abstract

The integration of advanced risk-pooling mechanisms in healthcare insurance is a critical strategy for enhancing system resilience and equity. Risk pooling, a foundational principle of healthcare insurance, involves aggregating financial resources to distribute healthcare costs more equitably across populations. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. This paper examines how innovative approaches to risk pooling can mitigate health disparities and improve health system performance amid economic and epidemiological challenges. Through a review of global practices and case studies, the study identifies key advancements in risk-pooling designs, including cross-subsidization, multi-tiered risk pools, and technology-driven actuarial analytics. The findings demonstrate that equitable risk pooling not only enhances healthcare access for vulnerable populations but also bolsters the financial stability of health systems. Nonetheless, challenges such as political resistance, data limitations, and implementation barriers remain. The study concludes with policy recommendations to address these obstacles and optimize risk-pooling mechanisms for sustainable and inclusive healthcare insurance models.