**4. Discussion**

This research compared the capability of the innovative six-dimension pooling risk framework of the health insurance-Bismarck model with the existing

#### *The Innovation of Six-Dimensional Pooling Risk Framework in Universal Health Insurance… DOI: http://dx.doi.org/10.5772/intechopen.106963*

three-dimension pooling risk framework, in financing the theoretical frameworks for transforming the determinant factors of health-related SDGs.

The world's leading causes of death are premature deaths from noncommunicable diseases, which continue to decline [25]. The progress has slowed in current years, so urgent and targeted programs will be required for key risk factors of noncommunicable diseases, which include tobacco use and alcohol consumption, hypertension, obesity, and physical inactivity [25]. Millions of people die from communicable diseases each year even though the number of deaths has declined [25]. The deaths from communicable diseases occur in lower-resource settings where many individuals cannot access quality healthcare services [25]. We must continue to concentrate on the equitable distribution of healthcare services and provide access to quality, affordable, and effective programs in all countries and for all populations, for closing these gaps and meeting SDGs [25].

Global action plans for the prevention and control of noncommunicable diseases 2013–2020 proposed a vision, goals, voluntary global targets, and objectives [26]. The vision of Global action plan is "A world free of the avoidable burden of noncommunicable diseases" and its goal is "To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by means of multisectoral collaboration and cooperation at national, regional and global levels, so that populations reach the highest attainable standards of health and productivity at every age and those diseases are no longer a barrier to well-being or socio-economic development" [26].

The WHO and partners approached the strategic framework for ending preventable maternal mortality (EPMM) [27]. The EPMM framework composed of SDG target 3.1: reduced global MMR to less than 70 per 100,000 live births by 2030 and five strategic objectives [27]. The five strategic objectives for EPMM include 1: To address inequities in access to quality of sexual, reproductive, maternal, and newborn health care, 2: To ensure universal health coverage for comprehensive sexual, reproductive, maternal, and newborn health care, 3: To address all causes of maternal mortality, reproductive, and maternal morbidities and related disabilities, 4: To strengthen health systems to respond to the needs and priorities of women and girls, 5: To ensure accountability to improve quality of care and equity [27].

The WHO African Region articulated the framework for provision of essential health services through strengthened district/local health systems to support UHC in the context of the SDGs [28]. The framework demonstrated the situation of universal healthcare services in the region, and the findings showed universal healthcare service coverage was 48%, universal essential healthcare service coverage was 36%, the accessibility of the population was 32%, and universal financial risk protection coverage was 34% [28]. The framework predicts that by 2030, 80% of the population will have access to essential healthcare services in 80% of Member States, and 80% of districts will have universal healthcare facility-community coverage in 80% of Member States [28].

The six-dimension pooling risk framework addresses communicable and noncommunicable diseases and inequity in low-density-population districts as determining factors of health-related SDGs for accelerating the progress. Therefore, the framework reallocates healthcare resources for communicable and noncommunicable disease healthcare services, equity in low-density-population districts, the strategic framework for ending preventable maternal mortality, global action plan for the prevention and control of noncommunicable diseases, the framework for provision of essential health services through strengthened district/local health systems of the WHO African Region. In contrast, the existing three-dimension pooling

risk framework is sickness fund approach, so it is not able to remobilize healthcare resources for those frameworks.
