Abstract

State-funded health insurance schemes are increasingly implemented across low- and middle-income countries, but utilization and acceptance often remain lower than desired for Universal Health Coverage. Including features that address the beneficiaries’ preferences could improve this. We conducted a discrete choice experiment to elicit preferences for a new public outpatient health insurance for low-income households in Pakistan in the design phase. We included five attributes that reflected dimensions of policy trade-offs during scheme design: health care providers, services, covered health conditions, coverage amount and premium. The main effects reveal relevance of all attributes and strong population preferences for including higher-level health care providers as well as telemedicine and for covering chronic disease needs. We found preferences for insurance attributes varied significantly by demographics and location, but found little variation by health status of the respondent or their household. This indicates that overall, preferences are rather homogeneous across groups, but preferences between females and males differed, and respondents from more remote areas had slightly different preferences from those in more urban areas. We further find suggestive evidence that in a setting with low insurance literacy, only some DCE choices were made to maximize benefits along known, pre-existing health complaints and risk factors.