Impacts of health insurance on health care utilization and health behaviors among older people in China

ABSTRACT Using three waves of the Chinese Longitudinal Healthy Longevity Survey in 2005, 2008–2009, and 2011–2012, this study investigates the effect of health insurance on health care utilization and health behaviors of older people in China. Enrollment in a health insurance program represents the main explanatory variable, while total health expenditures (THE), out-of-pocket expenditures (OOP), smoking, drinking and physical inactivity represent outcomes of interest. This study finds that health insurance is associated with an increase in THE and a reduction in OOP, suggesting that insurance enhances access to health services while reducing financial burden. The effects of insurance on health behaviors are complex, associated with increased probabilities of smoking and drinking and a decreased probability of physical inactivity. Results vary across age, education and residential location groups and across time, due to the fact that the health insurance system changed significantly during the study period.