**3. The formulation of the six-dimension pooling risk framework**

In this study, the existing three-dimension pooling risk framework was transformed to the six-dimension pooling risk framework, through the synthesis of three-dimension pooling risk framework of the health insurance scheme-Bismarck Model, with the functions of universal health insurance coverage program based on SDG 1,2,3,6, and10, the four levels of prevention, the district health system, and the district division administrative disaggregation data framework.

The innovative cross-subsidization of the six-dimension pooling risk framework is composed of 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 district residence subsidizing for health equity in low-density-population districts residence (**Figure 3**). The innovative cross-subsidization functions to subsidize for an insured person, to finance the four types of healthcare services, and to finance healthcare services in low-densitypopulation districts (**Figure 3**). Those functions address the determinant factors of health-related SDG targets, which are out of pocket, communicable diseases, noncommunicable diseases, and health inequity in low-density-population districts (**Figure 3**). Those functions interact with the determinant factors of health-related SDG targets financial risk protection (**Figure 3**).

The subsidization interacts with out of pocket schemes to offer financial risk protection for eradicating poverty in all its forms everywhere (**Figure 3**). Health promotion and disease prevention services transform behavioral factors, environmental factors, and epidemiological factors to reduce the morbidity and mortality rate of noncommunicable and communicable diseases (**Figure 3**). The reduction of morbidity and mortality rate creates healthy lives and promotes well-being for all at all ages (**Figure 3**). The six-dimension pooling risk framework finances healthcare services in low-density-population districts that aims to achieve health equity in lowdensity-population districts and to decrease inequality within and among districts of a country (**Figure 3**).

#### **Figure 3.**

*The six-dimension pooling risk framework.*

This study implies the guideline structure on how to implement the six-dimension pooling risk framework on a health insurance scheme. It recommends the premium equation of health insurance–Bismarck model is essential to restructure based on equity and probability of health and illness, for applying the six-dimension pooling risk framework in a health insurance scheme, to generate funds for financing the four types of healthcare services and leaving no low-density-populations districts behind. Furthermore, the guideline structure forms the premium of the framework to be between a government, employers, and employees. The framework has significant impact on economic growth, so the guidelines recommend the government to allocate resources from taxes to finance leaving no low-density-populations districts behind SDG1,2,3,6 and 10. The guidelines imply the employers need to contribute to the premium for financing community-related health promotion and disease prevention programs because the framework influences productivity. Furthermore, the framework functions to improve the quality of life of the insured population, so it is proposed the employees to contribute to the premium for financing personal-related health promotion and disease prevention programs. The package of benefits will be designated based on community and individual needs and the health-related SDGs targets. The package of benefits will address the social and microbiological determinants of health and inequity in low-density-population districts. The health insurance scheme pays providers of health promotion and disease prevention services at the community, healthcare facilities, educational institutions, and others. In contract, the providers provide health promotion and disease prevention services to the community and the individual. Future studies are needed to transform the guideline structure formula for the premium of the framework and to formulate health promotion and disease prevention services at all levels based on the WHO, the existing theoretical frameworks, and national frameworks for accelerating the progress on the health-related SDGs targets.
