Out-of-pocket payments provide freedom of choice for clients, and therefore, people often become more cost conscious when seeking care. However, Out-of-pocket payments make it difficult to achieve equity within the health system because access is often determined by a person's ability to pay. Furthermore, there are no safety net mechanisms to prevent or reduce any negative consequences impacting on the poor. Many advanced and middle-income countries have established prepayment systems or health insurance as an alternative to paying out-of-pocket. Such approaches include community financing schemes, voluntary health insurance, compulsory health insurance, and financing health care through general revenue. Risk pooling is a mechanism employed to distribute the financial risks and to cross subsidize health care amongst members of a prepayment or health insurance scheme