Does Social Health Insurance Influence Cognitive Impairments Among Older People? Evidence from Longitudinal Surveys in South Korea and China

Significant differences exist in the coverage and target population of social health insurance between South Korea and China. This study investigated the effects of different types of social health insurance on cognition trajectories and survival of older people with cognitive impairments. Data were drawn from the Korean Longitudinal Study of Aging (N = 1812) and the Chinese Longitudinal Healthy Longevity Survey (N = 1168) from 2008 to 2018. Growth mixture models were built to identify cognition trajectories. Logistic regression and Cox proportional hazards models were performed to identify risk factors. Results indicate that although social health insurance improved overall health outcomes among older people with cognitive impairments, there were significant socioeconomic inequalities in its protective influence. Results suggest that South Korea's Medical Aid and China's Basic Medical Health Scheme showed positive influences on cognition trajectories among illiterate older people. In contrast, results indicate that, in China, older adults with cognitive impairments from higher socioeconomic backgrounds benefited more from social health insurance in terms of cognition trajectories and survival. This study urges governments to consider expanding healthcare provision to protect the most vulnerable older people with cognitive impairments in general and those from low socioeconomic backgrounds in particular.