Health Insurance Pooling and Financial Protection Explorer

Explore how member contributions, employer or public subsidies, benefit coverage and cost sharing determine what enters an insurance pool, what the pool pays and what covered people still pay themselves.

1. Set the insurance arrangement

Move the controls or choose a preset. All amounts are annual and illustrative.

Covered members

Member contribution

The amount paid directly by each member.

Employer or public subsidy

Additional financing received per member.

Expected healthcare spending

Average annual spending before coverage rules.

Services covered

Deductible

Coinsurance

Out-of-pocket maximum

Applies to covered cost sharing, not contributions or excluded services.

Administration share

Contributions and subsidies

Available insurance pool

Expected claim payments

Total financing per member

member contribution plus subsidy

Expected pool payment per member

after benefit and cost-sharing rules

Expected point-of-care payment

covered cost sharing plus uncovered services

Illustrative funding balance

available pool funds minus expected claims

2. Compare financial protection at different spending levels

The member contribution is shown separately from costs paid when care is used. This makes clear that insurance can reduce exposure to a high-cost episode even when a person with little healthcare use pays more in contributions than the pool pays on their behalf that year.

Illustrative case	Healthcare spending	Pool payment	Point-of-care payment	Annual member cost including contribution	Reduction in point-of-care exposure

3. See how expected spending is divided

The bars divide expected healthcare spending between the insurance pool and the member. Member payments include covered cost sharing and spending on services outside the illustrative benefit package.

Share paid by the pool

Share paid at point of care

Member contribution

paid whether or not care is used

Subsidy share of pool revenue

employer or public financing

4. Interpret the model carefully

Insurance reallocates costs

Payments by members, employers or public bodies finance care received by people who need it. A member's payment and benefit will not normally be equal within a single year because sharing costs across people and time is the purpose of the pool.

Formal coverage is not complete protection

Deductibles, coinsurance, excluded services and limited provider access can leave substantial costs with members. Real evaluation must also examine access, quality, equity and whether covered services are actually available.

Available pool funds = total contributions and subsidies − administration
Pool payment = covered spending − covered member cost sharing
Funding balance = available pool funds − expected pool payments

This is a simplified teaching model, not a premium quotation or actuarial forecast. It represents every member with the same expected annual spending for the aggregate funding calculation and does not model reserves, risk variation, taxes, profit, provider prices, utilisation responses, adverse selection, reinsurance or changes over time.