Social Insurance and Older Adults in China: Effect of Education and Household Income on Coverage Following the 2009 Health Reform

Education and income have been considered two primary determinants to affect individuals' health outcomes. China initiated a comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothesized that older adults' years of education and income are determinants of participation in each social insurance scheme following the 2009 health reform. Multilevel logistic regression models were used with a nationally representative sample (n = 5,274) to investigate the education and income disparities in each social insurance scheme for older adults, with random effects among provinces at the national level. The analyses show that years of education was not associated with enrollment in three social insurances, with the exception of the association between 11 years of formal education or above and the rural coverage. Participants with higher levels of household income had greater odds of having urban social insurances, but had lower odds of having the rural scheme. Further research should continue to investigate the disparities of enrollment of each social insurance. Chinese policy makers should consider these social factors carefully to reach a true universal coverage.