Table 1.

Conceptual attributes and potential levels compiled from literature (adopted to the Malawian context)

Functions [46]	Based on the frameworks of Kutzin [46] , Berki and Ashcraft [47] , health insurance policy documents [48,49,50,51,52,53] literature on community perceptions on MHI characteristics in SSA [31,32,54,55,56,57,58,59,60,61,62,63] and attributes and levels defined in previous DCEs [23,24,25,26,27,28,29,30]
	Policy attribute	Plausible levels definition (citations only provided for previous applications in DCEs)
Revenue mobilization	Who pays the premium	Household members, employers[30], Government
	Unit of charging premium	Individual, household[26], full family[23,27]
	Structure of premium	• Flat rate[23,27]
		• Differential based on: income, employment, age, urban–rural
	Premium price (level)	• Based on real cost of healthcare
		• Based on proposed/existing insurance premiums[23,29,30]
		• Based on WTP or qualitative studies[25-27]
	Forms of premium payment	• Cash[23-27,29,30]
		• Material (farm produce) or both
	Premium payment mechanisms	• Deduction from bank or payroll[23], institutional membership (MFI) account, salary
		• Pay through community agents
		• Pay directly to insurance office
	Premium collection modalities	• Pay during wet, dry or all seasons
		• Pay weekly, two-weekly[26], monthly[23], yearly[29], installment
Fund and risk pooling	Unit of enrolment	Individuals[26], households, families[23], microfinance institutional or occupational groups
	Dependents eligibility	None, plus spouse, plus spouse and children[23]
	Extent of pooling	Family/kin, community, Institutional(MFI) level, district, region, nation
	Nature of cross-subsidization	• None
		• Based on income, employment, risk or geographical location status
		• Exemptions for poor and indigents
Pooled fund Management and administration	Who manages the pooled funds	• Names of insurance provider[26,27]
		• Community committees,
		• Microfinance Institutions,
		• NGOs, Health providers, Governmental organization
	Quality of customer services	Good, bad[25]
	Insurance information communication	Not provided, weekly, monthly[26], yearly
	Enrollment procedure (paper work involved)	• No forms to complete, few forms, lots of forms[26]
Services purchasing	Benefit package	Comprehensive, medium, basic packages
		Low cost vs. high cost events
		Low risk vs. high risk events
		Frequently occurring or rare events
a. Specific services coverage	• Hospitalization due to medical treatment or surgery[26]
	• Medical Consultation (by phone)[26]
	• Pharmaceuticals/drugs prescribed[25-27]
	• Preventive care, wellness and education[27]
	• Vision and hearing care[26,27]
	• Emergency services[26]
	• Mental health services[26,27]
	• Dental services[26,27]
	• Alcohol and substance abuse[26]
	• Treatment abroad or out of town emergency
	• Laboratory, x-ray and imaging
	• Maternal care
	• Consultations of traditional healers
	• Transportation
	• Loss of income when ill
	• Time loss of care giver
b. Cost sharing arrangements	Coverage ceiling (maximum liability)[28]	benefits within specific facilities, communities, district, national, international
	Co-payments levels	• None
		• Flat rate[23,30]
		• A percentage of cost (10%, 25%, 50%)[26,27]
	Deductibles[24,28]	• Out-of-pocket payment for first visit
		• Insurance pays only at a certain quantum of cost
	Benefit delivery	Cashless and re-imbursement
Provision	Type of providers	Public, private, faith-based or all
	Choice of provider (facility)	Choose any[27], limited to some, limited to one in the community[26], gatekeeper model
	Location of contracted provider	• Defined in terms of distance from home or average travelling time to provider[23,26]
		• Defined setting: urban, rural
	Quality of care	• Bad, moderate, good, very good, excellent[25-27]
	Reputation of affiliated providers	Outstanding, average, below average[23]
	Waiting time for care	Defined in terms of hours and minutes[26,29]
	Opening hours of health facility	Only week days, weekends as well, nights and 24 hours[26]
	Availability of providers	Yes/no[23]
	Involvement in treatment decision making	Yes/no[25]