Abstract
BACKGROUND: Financial risk protection is a core component of Universal Health Coverage. Rural residents in China continue to face the higher risk of catastrophic health expenditure. Developing a health insurance system for rural residents that ensures affordability and sustainability is critical to advancing Universal Health Coverage. This study aims to assess rural residents' preferences and willingness to pay for inclusive commercial health insurance. METHODS: This cross-sectional study was conducted among 520 rural households in Zhucheng County, China, using a structured questionnaire. A discrete choice experiment was employed to measure respondents' preferences and willingness to pay for inclusive commercial health insurance, followed by scenario simulations to estimate enrollment probabilities. RESULTS: Based on 497 valid responses, all attributes significantly influenced rural residents' preferences for inclusive commercial health insurance, except the deductible. Respondents preferred plans with government participation, equal compensation regardless of preexisting conditions, 80% reimbursement ratio, coverage for special medications, and low premiums. Government participation had the greatest impact. The optimal plan configuration increased the predicted enrollment probability by 99.6%. CONCLUSIONS: Strengthening government responsibility is the most effective strategy to increase rural enrollment in inclusive commercial health insurance. Additional measures include equitable coverage for preexisting conditions, optimizing benefit design, and setting reasonable premiums and deductibles. These findings offer actionable insights for improving inclusive commercial health insurance uptake among rural residents and provide transferable evidence for other countries seeking to advance financial risk protection under the UHC agenda through public-private insurance partnerships.