As aging process continues to accelerate in China, multimorbidity have become a major public problem that threatens the health of the entire population. In the current context of "Healthy China 2030", the health management of patients with multimorbidity needs to be urgently addressed.

To understand the preferences influencing the choice of community health services for patients with multimorbidity, explore the willingness to pay (WTP) of patients, so as to provide recommendations for improvements to the existing community health service system for chronic diseases.

Patients with multimorbidity were randomly selected from eight community health service centers in Chengdu during the period from May to August 2022 as survey subjects. General patient data and preferences related to discrete choice experiments were collected through on-site questionnaire surveys. Based on different types of comorbidities, patients with type 2 diabetes combined with hypertension, hypertension combined with coronary heart disease, type 2 diabetes combined with hypertension and coronary heart disease were categorized into ClassⅠ, ClassⅡ, and ClassⅢ. Regression analysis was conducted using mixed Logit model to analyze the preferences of multimorbidity patients for community health services, and to quantitatively analyze their WTP for community health services.

A total of 360 questionnaires were distributed and 296 valid questionnaires were recovered, with a valid recovery rate of 82.7%. ClassⅠpatients (β=3.260, 95%CI=2.610 to 3.910), ClassⅡpatients (β=3.697, 95%CI=2.612 to 4.781), and ClassⅢpatients (β=3.220, 95%CI=2.271 to 4.169) expressed the strongest preference for services with high accessibility to drugs, followed by appointment referral services and traditional Chinese medicine (TCM) services. Regarding physician types and prescription service duration, both ClassⅠpatients (β=0.971, 95%CI=0.585 to 1.357) and ClassⅡpatients (β=0.686, 95%CI=0.176 to 1.197) preferred services with extended prescription services, while ClassⅢpatients (β=0.804, 95%CI=0.196 to 1.413) preferred services provided by general practitioners (β=0.804, 95%CI=0.196 to 1.413). ClassⅠpatients (β=-0.049, 95%CI=-0.057 to -0.041), ClassⅡpatients (β=-0.040, 95%CI=-0.051 to -0.029), and ClassⅢpatients (β=-0.037, 95%CI=-0.048 to -0.027) preferred services with lower out-of-pocket expenses. The results of the regression analysis of WTP for patients with different chronic comorbidity types showed that the WTP of all 3 types of patients was related to their level of preference for each attribute, with ClassⅠ, ClassⅡ, and ClassⅢpatients all had the highest WTP for a high level of drug accessibility, which were RMB 66.77/month, RMB 91.97/month, and RMB 85.95/month, respectively.

Patients with multimorbidity exhibit significant preferences for six attributes considered in this study (physician type, TCM service, prescription service duration, drug accessibility, appointment referral, and monthly out-of-pocket costs). Drug accessibility is the most important attribute influencing multimorbidity patients' health service preferences. It is recommended to target patients' specific needs accurately, improve appointment referral services, establish standards for the management of chronic diseases in the community, and accelerate the integration of TCM into the prevention and treatment of chronic diseases in the community.

随着中国老龄化进程不断加快，慢性病共病成为威胁全民健康的重大公共问题，在当前"健康中国2030"的大背景下，慢性病共病患者的健康管理问题亟待解决。

了解影响慢性病共病患者选择社区卫生服务的偏好，探讨慢性病共病患者的支付意愿（WTP），对现有慢性病的社区卫生服务体系提供改善建议。

随机选取2022年5—8月成都市8家社区卫生服务中心的慢性病共病患者作为调查对象。通过现场问卷调查的方式收集慢性病共病患者的一般资料和离散选择实验偏好相关问题。根据共病不同类型将2型糖尿病合并高血压、高血压合并冠心病、2型糖尿病合并高血压及冠心病分别定义为Ⅰ类患者、Ⅱ类患者、Ⅲ类患者。采用混合Logit模型对慢性病共病患者社区卫生服务选择偏好进行回归分析，并量化分析慢性病共病患者对社区卫生服务的WTP。

共发放调查问卷360份，回收有效问卷296份，有效回收率为82.2%。Ⅰ类患者（β=3.260，95%CI=2.610~3.910）、Ⅱ类患者（β=3.697，95%CI=2.612~4.781）及Ⅲ类患者（β=3.220，95%CI=2.271~4.169）均最看重药品可及性高的服务，其次为预约转诊服务和中医药提供服务。关于医生类型和长处方服务，Ⅰ类患者（β=0.971，95%CI=0.585~1.357）和Ⅱ类患者（β=0.686，95%CI=0.176~1.197）均更偏好处方时间更长的服务，而Ⅲ类患者（β=0.804，95%CI=0.196~1.413）更偏好全科医生提供服务。Ⅰ类患者（β=-0.049，95%CI=-0.057~-0.041）、Ⅱ类患者（β=-0.040，95%CI=-0.051~-0.029）和Ⅲ类患者（β=-0.037，95%CI=-0.048~-0.027）均更偏好自付费用更低的服务。不同慢性病共病类型患者WTP的回归分析结果显示，3类患者的WTP均与其对各个属性的偏好程度有关，其中Ⅰ类患者、Ⅱ类患者、Ⅲ类患者均对药品可及性高水平的WTP最高，分别为66.77、91.97、85.95元/月。

慢性病共病患者对纳入的6个属性（医生类型、中医药提供服务、长处方服务、药品可及性、预约转诊及月自付费用）均有显著偏好。药品可及性是影响慢性病共病患者卫生服务选择偏好最重要的属性。建议精准定位患者需求，健全预约转诊，制定社区慢性病共病管理标准，加快中医药融入社区慢性病共病防治。