Table 2 Derivation of final list of DCE attributes and plausible levels (ordered from most preferred to least)

Unit of enrollment

How many family members will benefit from enrollment into the MHI scheme

• “If everybody in my family will benefit from this basket… it will be a good idea, … but if I am the only person to benefit since I will be the one contributing into the basket, then it is not a good idea since I will still be paying hospital bills for my dependents” (Non-SACCO men)

• Entire extended family

Yes

• “The head of the family should pay on behalf of the whole family” (SACCO women)

• Core nuclear family

• “If it offers a package covering them and their children, they will be more than happy to go for it” (Health worker at district hospital)

• Individual

Management

The managers of the common basket

• “Sometimes, just seeing the leaders who are managing this thing can make one to join or not” (SACCO men)

• Community committee

Yes

• “There should be an elected committee to run the basket and trusted people” (SACCO women)

• An external NGO

• “I will be happy if this basket is managed by the community for easy monitoring and accessibility” (Non-SACCO men)

• Bvumbwe SACCO

• “If the basket can be managed by the NGOs it can be a good thing because if it is managed by people of this community…. if they buy chicken with their own money, people might think that they are misusing the money from the basket” (Non-SACCO men)

• “I think the SACCCO can manage it but there should be a committee from the community …. linked to the SACCO, if it is managed by only SACCO there will be no trust” (SACCO-Men)

Health service benefit package

The health services that the MHI will pay for

• “There are some drugs which cannot be found at public hospitals except private hospitals, so this basket should cover these situations” (non-SACCO men).

• Comprehensive: Drugs, lab test/ x-ray, and surgical operations

Yes

• “(It should cover) x-ray and drugs, no more things (services) because we can’t manage to pay” (Non-SACCO men)

• Medium: Drugs, lab tests/x-rays

• “We have all agreed that medicine should be included in this basket” (SACCO women).

• Basic: Drugs only

• “They have to be sure that once they are putting money into this insurance, they are going to be covered properly” (health worker at private clinic)

Copayment

The proportion of health service bill that a MHI member is expected to pay out-of-pocket

• “The basket should be assisting with half of the bill not the whole bill” (SACCO women)

• None

Yes

• “25% (from the patient) is fair ….. because we should think of others who will also need the basket” (non-SACCO men)

• 25% (quarter)

• “It can happen that you are sick but you don’t have a single coin … the committee is telling you, you will only get 50% of your charge from the basket, the other half will be paid by yourself…it will mean the basket will be of no use” (Non-SACCO men )

• 50% (half)

Transport

Transport

• “I will join …… if I fall sick and this basket will cover transport to the hospital“ (SACCO Men).

• Always from home to the health facility any time sic

Yes

• “Private hospitals are very far from here so we need transport from this community to these private hospitals” (SACCO women)

• “Transport, because we have problems mainly in times of referral to Thyolo hospital” (district hospital) (Non-SACCO Men)

• Only during referral and emergencies

• “If they package involves offering transport to people from where ever they are to here, they will be more than happy to join” (health worker in public health center)

• none

Premium per person per month

Membership contributions

• “If the contributions will be unaffordable then I cannot join” (SACCO women)

• MWK100

Yes

• “We will manage MWK100 per month, if they charge more than that; people will not be able to pay” (Non-SACCO-women)

• MWK300

• ”We should agree on MWK500 per month” (Non-SACCO men)

• MWK500

• “The amount of money to be contributed whether is it monthly or how often” (health worker, private clinic)

Premium payment modalities

Frequency of premium contribution

• “Here, most of us find money on a seasonal basis, so I think it would be ideal if we contribute at the beginning of each and every year” (SACCO women)

• Once-off annual payment

No

• Monthly payment

• “Monthly contribution will help to have more money in the basket than annually” (non-SACCO men).

Provider network

Contracted healthcare facilities for service provision by the MHI

• “When a person falls sick and goes to private hospital, he should use the money from the basket to settle the bills because there is a difference between public and private hospitals in terms of treatment“ (non-Sacco men)

• Private –for-profit

No

• Faith-based (CHAM )facilities

• “They will like to go to private facilities” (Health worker, public facility)

• Public health facilities

Pooling level

Extent of geographical pooling

• “Each and every village has to have its own basket” (non-SACCO Women)

• Community level

No

• “I cannot be happy with district level” (non-SACCO Men) ”… there will be no trust and some will benefit from it while others will not benefit ……. unless it is at district level and managed by NGOs” (Non SACCO men)

• Traditional Authority

• District

Premium structure

Extent of dependency of contributions on earnings

• “It should be one figure because everyone whether one earns more or less can fall sick so it should be one figure” (SACCO Men).

• Flat rate contributions

No

• Contributions based on earnings