Flexible workers’ preferences for basic medical insurance for employees: a discrete choice experiment

With the rapid development of the digital economy and profound transformations in employment structure, the number of flexible workers has increased rapidly. Insufficient health protection has increasingly become a major challenge for this population. However, Basic Medical Insurance for Employees (BMIE) may remain insufficiently aligned with the needs of flexible workers, and little is known about how they trade off key design features of BMIE. This study examined flexible workers’ preferences for key BMIE attributes, their willingness to pay, and the sources of preference heterogeneity. This study used a choice-based discrete choice experiment focusing on five core attributes: monthly premium, outpatient reimbursement rate, inpatient reimbursement rate, benefit package, and waiting periods. The survey was conducted nationwide from March to May 2025. Flexible workers were recruited from public locations such as commercial areas and transportation hubs using snowball sampling. Participants were individuals aged 18 years or older but below the official retirement age who were not in formal employment or not engaged in a full-time employment relationship with an employer, and were enrolled in or eligible for individual participation in BMIE. A total of 503 flexible workers were invited, with 432 included in the final analysis (median age, 35 years, 52.6% male, 60.7% married, 85.9% enrolled in basic medical insurance). All five attributes were significantly associated with respondents’ choices among hypothetical BMIE alternatives. Monthly premium was the most important attribute, followed by outpatient reimbursement rate, inpatient reimbursement rate, benefit package, and waiting periods. Exploratory heterogeneity analyses suggested that preferences varied by age, gender, health status, and familiarity with medical insurance policies. This study provides stated-preference evidence on how flexible workers value different BMIE design features. Improving the relative attractiveness of BMIE may require better alignment between contribution arrangements, benefit design, and flexible workers’ heterogeneous preferences.