Residents’ preferences and willingness to pay for internet medical services in China from the demand-side perspective: a discrete choice experiment

Despite their rapid expansion across China, the adoption of Internet medical services remains suboptimal. Understanding the demand-side perspective—specifically, residents’ preference structures and their willingness to pay for key service attributes—is therefore a critical step toward improving their utilization. This study aimed to quantify the preferences of residents in China for Internet medical services, identifying the key determinants of choice, including the Internet hospital construction model, physician qualifications, service convenience, follow-up services, online response time, and out-of-pocket cost per service. We further sought to estimate the relative importance of these attributes, residents’ willingness to pay, and explore preference heterogeneity to inform the design of user-centered services for Internet medical services. A discrete choice experiment (DCE) was conducted, with attributes and levels established through a structured literature review, expert consultations, and a pilot survey. Preferences were analyzed using a mixed logit model to account for repeated choices and preference heterogeneity. Willingness to pay, relative importance, and scenario-based predicted probabilities relative to a predefined baseline profile were estimated based on the mixed logit results. Latent class analysis was further conducted to identify distinct preference patterns, and multinomial logistic regression was used to examine demographic characteristics associated with assigned latent class membership. Chinese residents’ choices of Internet medical services were shaped by both affordability and service quality. Out-of-pocket cost per service had the highest relative importance, followed by physician qualifications and online response time. Participants exhibited a willingness to pay an additional CNY ¥36.51 ( 95% CI : 24.91–48.10; based on an exchange rate of US $1 = CNY ¥7.20 on August 1, 2025) for a service provided by a chief physician versus an attending physician, and CNY ¥34.01 ( 95% CI : 24.79–43.24) to reduce the online response time from 60 min to 15 min. Scenario analysis showed that the predicted probability increased from 18.63% under the baseline profile to 83.25% under the fully optimized profile. These estimates represent simulated probabilities for specified service-profile comparisons rather than unconditional real-world uptake rates. Latent class analysis identified three distinct preference patterns, reflecting different trade-offs among cost, physician qualifications, response time, service convenience, and follow-up support. Younger age, higher educational attainment, and being married were associated with specific latent class membership, whereas sex, income, and residence showed limited explanatory value. The findings provide demand-side evidence for designing user-centered Internet medical services that balance affordability with service quality. Residents’ willingness to pay was characterized by both price sensitivity and value recognition, suggesting that providers should improve physician availability, response efficiency, follow-up support, and service convenience while maintaining affordability. Differentiated service packages and pricing strategies should be guided by underlying preference patterns rather than demographic characteristics alone. Given the underrepresentation of older adults and digitally less-proficient groups, these findings should be generalized cautiously, and future Internet medical services should incorporate inclusive designs, offline assistance, elderly-friendly interfaces, and community-based support.