Residents' preferences for inclusive commercial supplementary medical insurance: a discrete choice experiment

BACKGROUND: In China, inclusive commercial supplementary medical insurance (ICSMI) has developed rapidly, and the size of the insured population is critical for its long-term sustainability. To enhance the attractiveness of ICSMI and increase enrolment, it is necessary to improve scheme design based on residents’ choice preferences. METHODS: A discrete choice experiment was conducted to elicit residents’ preferences for ICSMI. Seven attributes and their levels were identified through a literature review, analysis of policy clauses of existing ICSMI schemes, and face-to-face interviews. A D-efficient design was used to generate 20 choice sets. A mixed logit model was applied to estimate overall preferences for ICSMI, calculate willingness to pay for different attribute levels, rank the relative importance of attributes, perform heterogeneity analysis and scenario simulation analysis. RESULTS: Among the 634 respondents, ICSMI schemes with lower premiums, government participation, broader coverage scope, lower deductibles, higher reimbursement ratios, reimbursement of pre-existing conditions, and one-stop settlement were preferred. Residents attached the greatest importance to the reimbursement ratio. The highest willingness to pay was observed for the coverage scope: respondents were willing to pay CNY 211.301 for the coverage scope from low scope to high scope. Subgroup and interaction analysis based on demographic characteristics showed heterogeneity in preferences for some attributes. Respondents with chronic diseases exhibited stronger preferences for a higher reimbursement ratio and one-stop settlement. When these two items are included in the product plan, their uptake rate will also increase significantly. CONCLUSIONS: Residents showed significant preferences for all attributes. This study provides preference evidence directly from the target insured population and offers a reference for optimising the design of ICSMI products.