Is social health insurance associated with smoking and alcohol consumption among Chinese older adults?

China launched a comprehensive health reform in 2009 to increase access to healthcare services and coverage rates. This study examined the associations of New Cooperative Medical Scheme (NCMS) and Urban Employment/Resident Basic Medical Insurance (UE/URBMI) with smoking and alcohol consumption among Chinese older adults. We extracted data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multivariable logistic regressions were conducted on the total sample (n = 9797) to examine smoking and drinking history. Negative binomial regression was performed on a subsample (n = 1442) to assess current daily cigarette usage. Gamma regression was employed on another subsample (n = 1422) to predict daily alcohol consumption. In the 2018 CLHLS sample, 15.69%, 30.38%, 14.51%, and 25.34% were current smokers, former smokers, current drinkers, and former drinkers, respectively. For current smokers, the mean daily cigarette consumption was 12.51 (SD = 8.99), and for current drinkers, the mean daily alcohol consumption was 2.57 liang (SD = 2.37). UE/URBMI coverage showed a statistically significant association with both smoking and drinking status prediction (all p < 0.001). However, there was no significant association between NCMS coverage and any of the outcomes. No significant associations were observed between major coverage of healthcare expenses and number of cigarettes smoked per day and daily alcohol consumption. The Chinese central government should incorporate health promotion benefits related to smoking and alcohol cessation programs.