Residents’ Preference Trade-offs for Critical Illness Insurance Scheme Design: A Discrete Choice Experiment in Shandong Province, China

The economic burden of disease remains a significant global public health challenge. In China, the Critical Illness Insurance scheme is a pivotal policy designed to protect households from catastrophic health expenditure. However, evidence on residents' preferences for this insurance is limited. Identifying these preferences is essential for advancing resident-centered policy reform. To address this gap, we conducted a discrete choice experiment to quantify public preferences for Critical Illness Insurance attributes among residents in Shandong Province, China. Through literature review, qualitative interviews, and expert consultation, we designed a discrete choice experiment with six policy attributes: cost, reimbursement ratio, deductible, annual reimbursement limit, scope of reimbursable expenses, and restriction to designated hospitals. An orthogonal design generated choice sets. Data were collected from 360 residents across three cities in Shandong Province and analyzed using mixed logit and latent class models. Latent class analysis identified preference heterogeneity across subgroups. Based on model results, we calculated relative importance scores and simulated selection probabilities. A total of 334 valid questionnaires were collected (46.4% male; 53.6% female). Mixed logit analysis identified the reimbursement ratio (32.73%) as the most important attribute, followed by the annual reimbursement limit (23.81%) and scope of reimbursable expenses (23.10%). Latent class analysis revealed two subgroups: a "Coverage-Intensity Sensitive" group (Class 1, n=125) and a "Reimbursement-Focused Group" group (Class 2, n=209). Class 1 prioritized high reimbursement limits (68.3% relative importance), preferring no annual limit. Class 2 emphasized optimizing the reimbursement ratio (45.6%) and hospital flexibility, while accepting higher deductibles. Policymakers should prioritize increasing reimbursement rates and expanding coverage scope, with appropriate premium adjustments. Aligning critical illness insurance design with residents' heterogeneous preferences contributes to more targeted and efficient policy arrangement.