*2.1.4 Proposed scoring for the decision criteria*

For each of the proposed criteria, a scoring scale was developed. The scoring definitions were mostly qualitative assessments and nonlinear. For example, the possible outcomes and related scores for "financial risk for insurance" were *high risk of nonmanageable cost increase* (exclusion), *increased but manageable cost increase* (25%), *minimal cost increase expected* (50%), *same cost as current* (75%), *decreased cost to insurance expected* (100%). In this example, exclusion means that an insurance option would be immediately excluded which can, with reasonable certainty, be expected to lead to massive financial impact to a degree which may bankrupt the insurance. Another example of a proposed scoring is the criterion of "equity" with the possible outcomes of "high degree of HC differences within population" (0%), "limited improvement of HC equity" (25%), "(limited) improvement of HC equity" (50%), "HC equity is mostly satisfied" (75%), "HC is the same for everybody" (100%).

Except for the score "exclusion," all scores are expressed in percentages. This method provides for a normalization within the scoring system even if each score does not have the same number of scoring levels. This also allows for differentiation between the importance of the possible outcomes. The final score for each criterion will be calculated from the score (in percentage) and the maximum score achievable by this criterion (described in Section 2.3).

#### **2.2 Interactive stakeholder workshop**

The interactive stakeholder workshop took place in Beijing, China, on September 14, 2018 under the leadership of Professor Shanlian Hu (Fudan University). The agenda started with introductory presentations on the policy changes which triggered the initiative. The view on the initiative from different perspectives (e.g., academic, policy, industry) was presented through a moderated discussion of participants' expectations and viewpoints on upcoming changes and the expected improvements in health insurance schemes. This was followed by an interactive component to develop a common general decision model following a validated MCDA calculation model and process for local adaptation [30, 35]. This portion of the workshop was moderated by two international health-policy advisors.

### **Figure 3.**

*Six-step process for developing the MCDA tool in a workshop with key decision-makers for prioritizing insurance policy options in China.*

Because the workshop facilitators spoke English, the entire workshop was supported by simultaneous translation to ensure involvement, understanding, and contribution of all participants. All materials were made available in the both languages.

The flow of the interactive part of the workshop is depicted in **Figure 3**.
