Social Health Insurance Programs and Preventive Care Utilization Among Chinese Older Adults: Results From the Chinese Longitudinal Healthy Longevity Survey

China has aimed to establish a universal health care system through a comprehensive health reform since 2009. However, knowledge about the association between basic social insurances and preventive care utilization (PCU) among Chinese older adults, especially as primary coverage, remains limited. This study investigates these associations using data from the 2018 Chinese Longitudinal Healthy Longevity Survey. We analyzed 9,952 older adults with major medical coverage from urban employee/resident insurance (UE/URBMI), cooperative medical programs (New Rural Cooperative Medical System; NCMS), or self-payment (SP). Propensity score matching (PSM) enhanced comparability between UE/URBMI or NCMS and a control group with SP coverage. Subsequent logistic regression examined associations between major medical expense coverage and PCU for older adults with NCMS + SP (<i>n</i> = 6,580) and UE/URBMI + SP (<i>n</i> = 5,248) groups, respectively. NCMS participants had higher odds of reporting PCU compared to SP users (odds ratio: 1.57, 95% CI: 1.40-1.75, <i>P</i> < .001). Conversely, no significant association was observed in the UE/URBMI + SP group (odds ratio: 1.08, 95% CI: 0.93-1.24, <i>P</i> > .05). This study highlights diverse associations between health insurance types and PCU among older adults. Empirical results suggest sustained government-led health insurance reform may need to continue progressing to strengthen financial incentives for PCU within the social insurance framework.